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IRLF 




FOR STUDENTS OF MASSAGE 

MARGARET E. EJORKEGREN 



SECOND EDITION 



PRICE Of- NET 



HANDBOOK OF ANATOMY FOR STUDENTS 
OF MASSAGE 



HANDBOOK OF ANATOMY 
FOR STUDENTS OF MASSAGE 



BY 

MARGARET E. ^BJORKEGREN 

TEACHERS' CERTIFICATE, INCORPORATED SOCIETY TRAINED MASSEUSES 
INTER. (M.B.) LOND. 



SECOND EDITION 



WITH 73 ILLUSTRATIONS 

TAKEN FROM "A MANUAL OF ANATOMY," BY A. M. BUCHANAN, 
M.A., M.D., PROFESSOR OF ANATOMY, ANDERSON'S COLLEGE, GLASGOW 




LONDON 

BAILLIERE, TINDALL & COX 

8, HENRIETTA STREET, COVENT GARDEN 

1917 

A II rights rcstrved 



M. Z 6 

6 fc 
/'Y 






PREFACE TO THE SECOND EDITION 

IN preparing the Second Edition I have made numerous altera- 
tions and small additions which I trust will improve the useful- 
ness of the book, the principal alteration being the considerable 
enlargement of the chapter on Surface Markings, which I 
recognized was not adequate to the standard required by the 
examinations of the Incorporated Society of Trained Masseuses. 

MAEGAEET E. BJOEKEGEEN. 

LONDON, 

May, 1917. 



377330 



PREFACE TO THE FIRST EDITION 

THIS book has been compiled with the object of meeting a want, 
to which my attention was repeatedly called by my students 
when preparing them for the examinations of the Incorporated 
Society of Trained Masseuses. No book dealing with Anatomy > 
especially arranged for students of massage, has yet been 
written, and I have endeavoured to make good this deficiency to 
the best of my ability. It is hoped that this small volume will 
be found to embody all the ground covered by the syllabus 
of this Society for its examinations in Massage and Swedish 
Remedial Exercises. 

Professor A. M. Buchanan of Glasgow has been good enough 
to allow me to select what illustrations I have thought necessary 
from his " Manual of Anatomy." I take this opportunity of 
tendering him my sincere thanks for his courtesy. Through his 
kindness I am thus able to offer my readers a far better and more 
freely illustrated book than would have been possible if special 
figures had had to be made. In a few of the illustrations some 
parts are shown which are not referred to in the text. As the 
pointers to them appeared in the original figures, it was con- 
sidered advisable to retain them, since their removal might 
have caused damage. 

Within the scope of a small work it is obviously impossible to 
include more details and explanations than are absolutely neces- 
sary; but it will, I hope, be found sufficiently full and accurate 
to render it a useful textbook for those attending classes and 
lectures on Massage, and afterwards to be of assistance to them 
in their practice. 

MAEGARET E. BJORKEGREN. 

LONDON, 

September, 1914. 



CONTENTS 

SECTION PAGK 

I. INTRODUCTION - - - 1 

II. SHOULDER GIRDLE AND UPPER LIMB - - 5 

III. PELVIC GIRDLE AND LOWER LIMB - - 39 

IV. VERTEBRAE, RIBS, AND MUSCLES OF TRUNK 78 
V. BONES AND MUSCLES OF HEAD - 100 

VI. DIGESTIVE SYSTEM - 116 

VII. DUCTLESS GLANDS, KIDNEYS AND PELVIC ORGANS - - 127 

VIII. RESPIRATORY ORGANS - - 131 

IX. HEART AND BLOODVESSELS OF HEAD, NECK AND TRUNK 137 

X. BLOODVESSELS OF THE UPPER LIMB - - 157 

XI. BLOODVESSELS OF THE LOWER LIMB - 163 

XII. LYMPHATIC SYSTEM - 169 

XIII. BRAIN, SPINAL CORD, NERVES OF TRUNK, AND SYMPATHETIC 

SYSTEM ......... 172 

XIV. CERVICAL PLEXUS - 181 

|XV. BRACHIAL PLEXUS AND NERVES OF UPPER LIMB - - 184 

XVI. LUMBAR AND SACRAL PLEXUS AND NERVES OF LOWER LIMB 192 

XVII. CRANIAL NERVES 204 

XVIII. SURFACE MARKINGS - - - - - - 210 



INDEX ....... 224 



LIST OF ILLUSTRATIONS 



ITAUA 

1. THE EIGHT CLAVICLE (SUPERIOR VIEW) - - 6 

2. THE EIGHT SCAPULA (POSTERIOR VIEW) - - 7 
8. THE EIGHT HUMERUS (ANTERIOR VIEW) - - 

4. THE EIGHT EADIUS AND ULNA (ANTERIOR VIEW) - - 11 

5. BONES OF THE EIGHT HAND (ANTERIOR VIEW) - - 14 

6. MUSCLES OF THE SHOULDER-JOINT - - 18 

7. THE ELBOW-JOINT - 22 

8. MUSCLES OF THE "UPPER ARM _ 24 

9. MUSCLES OF THE FOREARM (DORSAL ASPECT) - - 27 

10. MUSCLES OF THE HAND (PALMAR ASPECT) - - - 32 

11. INNOMINATE BONE - - 40 

12. PELVIS - - 42 

13. FEMUR _ 44 

14. TIBIA AND FIBULA (ANTERIOR SURFACES) - - 46 

15. TIBIA AND. FIBULA (POSTERIOR SURFACES) - - 48 

16. BONES OF FOOT (DORSAL SURFACE) - - 50 

17. BONES OF FOOT (PLANTAR SURFACE) - 52 

18. HIP- JOINT - - 55 

19. MUSCLES AND CUTANEOUS NERVES OF LEG (POSTERIOR VIEW) - 60 

20. MUSCLES AND CUTANEOUS NERVES OF LEG (ANTERIOR VIEW) - 61 

21. KNEE-JOINT (POSTERIOR VIEW) _ 62 

22. ANKLE-JOINT - - - 67 

23. MUSCLES OF LEG - - 69 

24. SHORT MUSCLES AND ARTERIES OF FOOT _ 75 

25. A TYPICAL VERTEBRA - - - > - 78 

26. SACRUM (ANTERIOR SURFACE) . . 80 

27. SACRUM (POSTERIOR SURFACE) _ 81 

28. ATLAS . . 31 

29. Axis - ------ 82 

30. SPINAL COLUMN _ g4 

31. STERNUM . . _ - 85 

32. A TYPICAL EIB . 87 

33. THORAX - _ - 88 

34. VERTEBRAL LIGAMENTS . 90 



x LIST OF ILLUSTRATIONS 

FIG. PAGE 

35. MUSCLES OF THE BACK - 91 

36. MUSCLES OF THE ABDOMEN - - 92 

37. INTERCOSTAL MUSCLES - 97 

38. THE LATERAL KEGION OF THE SKULL (NORMA LATERALIS) 101 

39. THE EXTERNAL BASE OF THE SKULL - 103 

40. THE FRONTAL BONE 104 

41. THE OCCIPITAL BONE 105 

42. THE EIGHT TEMPORAL BONE 106 

43. THE SUPERIOR MAXILLA - 108 

44. THE INFERIOR MAXILLA (MANDIBLE) 109 

45. THE TEMPORO-MANDIBULAR JOINT - 111 

46. THE PERITONEUM - 118 

47. THE STOMACH 119 

48. THE SALIVARY GLANDS 123 

49. THE LIVER 124 

50. THE SPLEEN - 128 

51. THE PHARYNX 132 

52. THE LARYNGEAL CARTILAGES 133 

53. THE PLEURA 135 

54. THE HEART - 138 

55. THE AORTA - 141 

56. THE AORTA IN THE THORAX, AND THE PRINCIPAL ARTERIES OF 

THE HEAD AND NECK - 144 

57. THE ABDOMINAL AORTA 147 

58. THE INFERIOR MESENTERIC ARTERY AND ITS BRANCHES - - 150 

59. VEINS AND GLANDS OF HEAD AND NECK - 153 

60. THE BRAIN (SIDE VIEW) 172 

61. BASE OF THE BRAIN 173 

62. CUTANEOUS NERVES OF TRUNK 178 

63. NERVES IN POSTERIOR TRIANGLE OF NECK 182 

64. VESSELS AND NERVES IN NECK - - 183 

65. THE BRACHIAL PLEXUS 184 

66. CUTANEOUS NERVES OF UPPER LIMB (POSTERIOR SURFACE) 187 

67. CUTANEOUS NERVES OF UPPER LIMB (ANTERIOR SURFACE) 188 

68. LUMBAR PLEXUS 193 

69. SACRAL PLEXUS 196 

70. MUSCLES AND CUTANEOUS NERVES OF LEG (POSTERIOR VIEW) 200 

71. MUSCLES AND CUTANEOUS NERVES OF LEG (ANTERIOR VIEW) 201 

72. NERVES OF HEAD AND FACE 207 

73. PLANE OF ABDOMEN - - - - - - 213 



SECTION I 
INTRODUCTION 

ANATOMY means really the study of the body, its different 
parts and their functions, comprising histology, physiology, and 
many other sciences ; but the generally accepted definition is, 
that the science of anatomy is the study of the body as far 
as it can be done by dissection and the naked eye. It is 
necessary, therefore, to have certain well-defined terms for the 
purposes of description ; it is always assumed that the body is 
in the erect position with the arms by the sides, the palms 
turned forwards and the thumbs outward. 

Sections are generally taken through the three following 
planes : 

1. Transverse, or horizontal plane. 

2. Sagittal a vertical plane in the antero -posterior direction. 

3. Frontal a vertical plane at right angles to the sagittal. 

The Mesial Plane is the sagittal one that divides the body 
in two halves, and is represented in front by the anterior 
median line, and behind by the posterior median line : the two 
halves are supposed to be symmetrical ; but like all things of 
Nature's manufacture, are not rigidly so. Certain unpaired 
organs, that are not in the middle line, also render the two 
halves asymmetrical. 

The terms internal and external are used to express positions 
nearer to, or farther from, the middle line respectively; the 
terms dorsal and ventral are positions nearer the back or front 
of the body respectively; posterior and anterior are synonymous 
with dorsal and ventral ; superior and inferior indicate nearer the 
head or the feet respectively. In the case of the limbs, the 

1 



^HANDBOOK OF ANATOMY 

terms proximal and distal are used to indicate positions near 
to or distant from the trunk. 

The body consists of a bony framework, the component parts 
of which are jointed together, the joints being the fulcrums 
of the levers formed by the muscles. As well as the skeletal 
and muscular systems, the circulatory, respiratory, digestive, 
and nervous systems also have to be studied. 

The Skeletal System. The bones are classed as long, short, 
flat, or irregular, according to their shape. They are all laid 
down in cartilage in the embryo, and become ossified at different 
stages. Various centres of ossification are laid down in different 
parts of the bone, so that each part can continue growing 
until the adult size is reached, by which time the different 
centres of ossification have coalesced and the bone is completely 
ossified. A sesamoid bone is one that is developed in a tendon 
passing over a joint where there is a great deal of friction. 

Joints are formed by the ends of two bones in apposition to 
one another. Fibrous bands, called " ligaments," hold them to- 
gether, and these generally join one another so as to form a 
complete capsule round the joint. The opposed ends of the 
bones are covered with cartilage of a particularly tough kind 
to prevent wear by friction. In some cases where the joint has 
constant work e.g., the knee-joint an extra piece of cartilage 
in the form of a disc is found between the bones. The whole 
structure is lined by synovial membrane a thin membrane 
which secretes a fluid for the purpose of lubrication. 

The skeleton consists of a vertebral column which supports the 
trunk, and on the top of which is the head, on the freely 
movable cervical vertebrae ; the lower end of the vertebral 
column is firmly welded together to support the weight of the 
body. The upper half of the body the thorax is protected 
by a bony framework formed by the ribs, which are elastic 
and freely movable, to give free play to the lungs. The lower 
half of the trunk, the abdomen, has only partial bony pro- 
tection and a strong muscular wall composed of three layers 
of muscles with the fibres arranged in different directions, so 
that they can exert strong contractile force. 

The limbs are similiar in structure as to the number and 



INTRODUCTION 3 

arrangement of their bones and joints; but in every particular 
it will be noticed that the upper limb is constructed with a view 
to wide scope of movement and lightness, whereas the con- 
struction of the lower limb tends to stability and weight. They 
are each attached by a ball-and-socket joint to a bony girdle. 
But compare the shoulder girdle with the pelvic : the socket in 
the one case is shallow and much smaller than the ball; in 
the other the ball is received into a deep socket that covers it 
up to the neck. The shoulder-girdle is connected anteriorly 
to the trunk by a loose gliding joint, and posteriorly slung 
by muscles. The pelvic girdle is firmly welded together in 
front, and behind is almost immovably joined to the lower 
vertebrae, whose joints are completely ossified. The reason 
for this is easily seen when the functions of the upper and 
lower limbs are compared. 

The Muscular System. The flesh of the body consists of 
:a number of muscles which are attached at each end to bones. 
They are capable of contraction, the attachment from which 
they pull being termed the " origin," and the one on which they 
pull, the " insertion." A muscle or its tendon passes over one or 
more joints, and its principal action is on the joint nearest the 
insertion. 

The Circulatory System. The tissues are nourished by the 
blood, which is carried to all parts by the arteries and returned 
T)y the veins. The heart is the starting-point of the system, 
and by its action the blood is sent on its way at a certain 
pressure. 

The Respiratory System consists of an air passage from 
the mouth and nose to the lungs, the latter situated in the 
thorax, where the blood is reoxygenated. 

The Digestive System consists of the alimentary canal, 
iDy which food is taken in at the mouth, passed down to the 
stomach and duodenum to be digested, into the small intestine 
to be absorbed, and the residue into the large intestine to be 
excreted. Accessories to the digestive system are the organs 
which secrete digestive juices and pour them into the alimentary 
canal. 

The Nervous System is in two parts the cerebro-spinal 



4 HANDBOOK OF ANATOMY 

and sympathetic. The cerebro-spinal, consisting of the brain 
and spinal cord, is formed largely of grey matter, which con- 
sists of the actual nerve cells, and sends distributing fibres in 
every direction, so that each muscle receives both an efferent 
and afferent branch. The sympathetic is an accessory system. 

The whole body is covered by a thin tough membrane called 
the " deep fascia," which closely invests the muscles, and send& 
down processes, or dividing septa, between them. From the 
deep fascia and the intermuscular septa many of the muscles' 
get additional origins, and in some cases muscles are inserted 
into adjacent fascia as well as bones. Outside this is the super- 
ficial fascia, a thin friable membrane enclosing fat in its 
meshes. This fascia is also found in spaces between muscles, 
bones, and organs to prevent jarring and give elasticity. Over 
all is the skin, from which the hair and nails are developed. 



SECTION II 
THE SHOULDER GIRDLE AND UPPER LIMB 

THE upper limb is articulated to the trunk by means of a 
ball-and-socket joint between the humerus and scapula. The 
limb is slung to insure as much mobility as possible, the joint 
being a very loose one, and the scapula is attached to the trunk 
by muscles between it and the vertebras at the back, and to the 
clavicle in front. The scapulae and clavicles form what is known 
as the Shoulder Girdle. 

The bones to be described in the shoulder girdle and upper 
limb are the following : 

Clavicle, articulated internally to the sternum ; externally, to 
the acromion process of scapula. 

Scapula, articulated externally to acromial end of clavicle and 
to head of humerus. 

Humerus, articulated above to glenoid cavity of scapula ; 
below, to heads of ulna and radius. 

Ulna, articulated above to internal condyle of humerus and to 
head of radius ; below, to triangular fibro-cartilage of wrist- 
joint. 

Radius, articulated above to external condyle of humerus and 
to head of ulna ; below, to the scaphoid and semilunar bones of 
the carpus. 

Carpus, articulated above to radius ; below, to five metatarsals. 

Metatarsals, articulated above to bones of carpus ; below, to 
phalanges. 

Phalanges : First row articulated above to metatarsals ; 
below, to second row of phalanges. 

Second row above, to first row of phalanges ; below, to 
third row of phalanges. 



() HANDBOOK OF ANATOMY 

Third row above, to second row of phalanges. 

The Clavicle is a long bone having a prismatic shaft, and at 
its inner (sternal) end a rounded head ; while its outer (acromial) 
end is flattened into a more or less square shape. The shaft 
forms a double curve, being convex forwards internally and 
convex backwards externally ; the upper surface, subcutaneous 
throughout, is rounded and smooth ; the anterior border is 
rough, internally for the attachment of the pectoralis major,, 
and externally for that of the deltoid; the posterior border 
is roughened internally for the attachment of the sterno-mastoid, 
and externally, where the acromion process begins, there is a 
tubercle, called the conoid tubercle, for the attachment of the 
conoid ligament. The inferior surface is also rough ; at its 



Acromial Facet 




Sternal 
Extremity 



FIG. 1. THE RIGHT CLAVICLE (SUPERIOR VIEW). 

sternal end there is a deep pit for the attachment of the 
rhomboid ligament, and in its middle third a groove for the 
subclavian muscle ; from the conoid tubercle, outwards and 
forwards, proceeds an oblique ridge for the attachment of the 
trapezoid ligament. 

The clavicle articulates internally with the upper end of the 
sternum, and externally with the acromion process of the scapula. 

Ossification. The clavicle is the first bone of the body to 
ossify, the process commencing in the shaft very early in foetal 
life. The secondary centre, or epiphysis, appears at the sternal 
end in adult life, and ossification is complete about the twenty- 
fifth year. 

The Scapula is a flat, triangular bone having two surfaces, 
anterior and posterior, and three margins, vertebral, axillary, and 



BONES OF SHOULDER GIRDLE 7 

superior. Between the upper and second fourth of the vertebral 
border on the posterior surface there starts a process, which 
passes right across the dorsum of the bone, and ends in the 
acromion process. From the external end of the superior border 
projects a beak-like process called the coracoid. Immediately 
to the inner side of the root of the coracoid process is the 
suprascapular notch. 



Posterior Belly of Omo-hyoid. 
Supraspinous Fossa and Supraspinatus \ 

Superior Angle ' 

Levator Anguli bcapule 
I 



Spine 

For Tendon 

of Trapezins 

Rhomboideus Minor 



Rhomboideus Major 
Infraspinous Fossa 
and Infraspinatus 

Groove for Dorsalis 
Scapulae Artery 



Suprascapu 
' Notch 



lar Coracoid 

Process Trapezius 



Great 
^capular Notch 
Glenoid Cavity 



Infraglenoid Ridgs 

and L< ng Head 

of Triceps 




>*. Axillary Border 
N Teres Minor 



*-. Teres Major 



""-. Inferior Angle 



Latissimus Dorsi 

FIG. 2. THE RIGHT SCAPULA (POSTERIOR VIEW). 



The superior angle (vertebral end of superior border) is more 
or less rectangular, and the inferior angle very acute. At the 
junction of the outer end of the superior border and the upper 
end of the axillary border is the glenoid cavity, a pyriform, 
slightly concave area, which receives the head of the humerus, 
thus forming the shoulder- joint. The coracoid process arises 
just internal to the glenoid cavity, and, bending on itself forwards 



8 HANDBOOK OF ANATOMY 

and outwards, overhangs the glenoid surface ; it is very much 
roughened for the attachment of muscles and ligaments. 

The anterior, or ventral, surface of the bone is concave, and 
has several rough lines on it, caused by the attachment of the 
subscapular muscle. The axillary border on this surface is full 
and rounded, the vertebral border being roughened. Both 
borders give attachment to muscles. 

The posterior dorsal surface is divided into an upper smaller 
fossa and a lower larger fossa by the spine, which runs from 
the vertebral border outwards and upwards to the glenoid 
cavity. Both fossse give attachment to muscles. The spine 
is separated from the edge of the glenoid cavity by the great 
scapular notch ; the posterior border is subcutaneous, and is 
lipped for the attachment of muscles; at the great scapular 
notch it is flattened to form the acromion process, which passes 
forwards and outwards to overhang the joint, and gives attach- 
ment to muscles and ligaments. 

The scapula articulates by means of the glenoid cavity with 
the head of the humerus, and by the acromion process with the 
acromial end of the clavicle. 

Ossification. At birth the coracoid and acromion processes, 
the glenoid cavity, and vertebral border are still cartilaginous. 
Secondary centres appear in these from birth up to puberty, 
and the bone is complete about the twentieth year. 

The Humerus is a long bone with a shaft and two extremities ; 
it is the bone of the upper arm. It has a rounded head forming 
about one-third of a sphere, which is bounded by the anatomical 
neck, a shallow depression all round the head, much less marked 
inferiorly. On the outer side of the head is the great tuberosity, 
which becomes continuous with the shaft, and has facets for 
the attachment of muscles. On the anterior surface of the 
upper end is the lesser tuberosity, which also becomes con- 
tinuous with the shaft. Between the two tuberosities lies the 
bicipital groove, which gives attachment to the adductor 
muscles. Below the head and tuberosities the bone decreases 
in size, and this is called the " surgical neck," as it is the part 
most easily fractured. 

The shaft is cylindrical above, but gets flatter lower down. 



BONES OF LOWER LIMB 



Anatomical Necl 

A Large Nutrient Foramen x 

Great Tuberosity and 

fcupraspinatus 

Infraspinatus ~ 



/ 'IA 



Jiimall Tuberosity and Subrcapukvis 



Surgical Neck 



.Bicipital Groove 
Latissimus Dorsi 



Pectoralis Major 



Teres Major 



Deltoid 



-.Coraco-brachialh 
Medullary Foramen 



Brachio-rad ialis 



Brachialis Anticus 

Txternal Supracondylar Ridge. 



Internal Supracondylar Ridge 



'-Extensor Carpi Radialis Longior // 



Radial Fossa 
External Epicondyle.( 



Common Origin of ' 
Extensor Carpi Radialis Brevier 
Kxtensor Communis Digitorum 
Extensor Minimi Digiti 
Kxtensor Carpi Ulnaris, and 
-Supinator Radii Brevis 



Capitellum 



Trochlea 



,Coronoid Fossa 

k Superficial Head of Pronator 

Radii Teres 

Internal Epicondyle 



v Common Origin of 
Flexor Carpi Radialis 
Palmaris Lnngus 
Flexor Sublimis Digitorum, and 
Small Head of Flexor Carpi 
Ulnaris 



FIG. 3. THE RIGHT HUMERUS (ANTERIOR VIEW). 



10 HANDBOOK OF ANATOMY 

The bicipital groove passes down its anterior surface, directed 
slightly to the inner side, and gradually fades away. About 
the middle of the inner and outer surfaces are rough surfaces 
for the insertions of the coraco-brachialis and deltoid respectively. 
On the posterior surface a shallow groove the musculo-spiral 
groove winds from within outwards, separating the origins of 
two heads of the triceps. The lower end of the shaft is flattened 
and expanded into two condyles, of which the inner is larger 
than the outer. From each of these condyles a ridge runs up 
for about one-third of the shaft. Between the two condyles are 
the trochlear and capitellar surfaces for the articulation of the 
ulna and radius respectively. The trochlea is a grooved surface, 
which winds spirally round the inferior end of the bone and 
shows on the posterior surface. The capitellum is on the outer 
side of the trochlea, a small, rounded surface which shows only 
on the anterior surface. Above the trochlea, both anteriorly 
and posteriorly, are small, round fossse, the coronoid and ole- 
cranon respectively, for articulation with the processes of the 
ulna in extreme flexion and extension. 

The humerus articulates, by means of its rounded head, with 
the glenoid cavity of the scapula, and at its inferior end with 
the ulna and radius. 

Ossification. The primary centre for the shaft appears before 
birth. Secondary centres for the two tuberosities and the head 
appear during the first few years of life, and these three first 
unite, forming an epiphysis, which unites with the shaft as a 
whole in adult life. A similar arrangement is observed with 
the condyles and articular surfaces of the lower end, which 
also form a separate epiphysis. 

The Ulna, the inner bone of the forearm, is a long bone 
with a shaft and two extremities. The head is formed of two 
processes, the olecranon posteriorly and the coronoid anteriorly. 
The olecranon process forms a continuation of the shaft, and is 
hollowed out anteriorly for articulation with the trochlear sur- 
face of the humerus. Tne coronoid process juts out from the 
anterior surface of the shaft, and its upper surface is in con- 
tinuation with the anterior surface of the olecranon process, the 
two between them forming the semilunar notch or sigmoid fossa.. 



BONES OF UPPER LIMB 



11 



Head of Radius 



Neck 



Olecranon Process 

Semilunar Notch r 
Sigmoid Fossa 



,Coronoid Process 
..Flexor Sublimis Digitorumi 

Brachialis Anticus 



Posterior part of Bicipital 
Tuberosity and Tendon 
of Biceps 

Supinator Radii Brevis 4 



Anterior Oblique Line - _ _. 



Medullary Foramen i 

Flexor Longus Pollicis .-- j- 
Pronator Radii Teres 



r 



Medullary Foramen 

.-Anterior Border 

Flexor Profundus Digitorunt 



Anterior Border .-. 



Pronator Quadratus 



._l| Pronator Quadratus 



Brachio-radialis _. 



--Head 

. _ Styloid Process of Ulna. 



Styloid Process of Radius 

FIG. 4. THE RIGHT RADIUS AND ULNA (ANTERIOR VIEW). 



12 HANDBOOK OF ANATOMY 

On the outer side of the upper end of the shaft is another articular 
surface, the radial notch, for articulation with the head of the 
radius. The posterior surface of the olecranon is smooth and 
subcutaneous. Just below the coronoid process is a rough 
tuberosity for the insertion of brachialis anticus. The shaft 
is triangular for about two-thirds of its length, then tapers 
gradually, and becomes smooth and rounded. It has three sur- 
faces anterior, inner, and outer and three borders posterior, 
inner, and interosseous. The posterior border is subcutaneous 
throughout its .length. The lower end of the bone is much 
smaller than the upper, and nearly circular. On its inner surface 
it has a projection, the styloid process, pointing downwards, 
and on its outer surface an articular facet for the lower end of 
the radius. The inferior surface is smooth for articulation 
with the triangular nbro-cartilage of the wrist- joint. 

The ulna articulates above with the trochlear surface of the 
humerus by means of the semilunar notch, and below with the 
articular disc of the wrist-joint ; on its outer surface it articulates 
with the radius at either extremity. 

Ossification. The centre for the shaft appears before birth, 
and secondary centres for the olecranon process and the lower 
end of the shaft appear later to form epiphyses which unite with 
the shaft in adult life. 

The Radius, the bone on the outer side of the forearm, is a 
long bone with a shaft and two extremities it differs from the 
ulna in having a small rounded head and a shaft which gradually 
widens out so that the lower extremity is much larger and 
triangular in shape. The head is circular, with a cup-shaped 
depression on its superior surface; it has a narrow articular 
surface all round for articulation with the radial notch of the 
ulna. Immediately below the head it is somewhat constricted to 
form a neck, and then widens out again into the shaft. The 
shaft is triangular in section, having three surfaces anterior, 
outer, and posterior and three borders, the interosseous one 
being the only well-defined one, as the surface is rounded and 
confluent with the other two. At the upper and inner side of the 
anterior surface is the bicipital tuberosity for the insertion of 
the biceps, and from the lower jedge of that the oblique line 



BONES OF UPPER LIMB 13 

passes across the anterior surface of the bone to the middle o 
the outer border. The lower end of the shaft is distinctly 
triangular ; the edge of the narrow interosseous surface articu- 
lates with the lower end of the ulna; the anterior surface is 
smooth and concave, the posterior having a series of grooves for 
the extensor tendons to work in. On the radial border is a 
styloid process similar to that of the ulna. 

The radius articulates above by means of the upper surface of 
its head with the capitellum of the humerus, and the lower end 
articulates with the scaphoid and semilunar bones of the carpus ; 
on its interosseous surface it articulates at both ends with the 
ulna. 

Ossification. Similar to that of the ulna. 

The Carpus consists of eight bones arranged in two rows of 
four. The proximal row beginning from the radial side are 
scaphoid, semilunar, cuneiform, and pisiform.; the distal row, 
beginning from the radial side, are trapezium, trapezoid, os mag- 
num and unciform. They are all small irregular-shaped bones 
articulating with one another. The bones are articulated so 
that their united surface is convex backwards. 

The pisiform is the smallest of the bones and is a little round 
bone resting entirely on the palmar surface of the cuneiform ; it,, 
with the hook of the unciform, forms the projection on the 
ulnar side of the wrist ; the tubercle of the scaphoid and ridge 
of the trapezium form the projection on the radial side of the 
wrist. 

The unciform is distinguished by having a hook-like process 
on its palmar surface. 

The proximal row of bones articulates above with the radius 
and triangular fibro-cartilage, and below with the distal row of 
bones. The distal row of bones articulates below with the five 
metatarsal bones; the first metatarsal with the trapezium; the 
other four fitted into the trapezoid, os magnum, and unciform. 

Ossification. One centre for each bone appears after birth, 
and the carpus is usually completely ossified at puberty. 

The Metacarpus consists of five bones; they are all long 
bones, with a shaft and two extremities. The shafts are con- 
stricted in the middle and curved so that they are slightly 



14 



HANDBOOK OF ANATOMY 



convex backwards ; the carpal ends or bases of all, except the 
first, are more or less wedge-shaped, and the heads of all are 
rounded. 

The first metacarpal is the shortest and stoutest of the five 



Abductor Pollici 
Opponens Pollicis 

Superficial Head of Flexor ...... 

Brevis Pollicis 
Ext. Ossis Metacarpi Poll.----^ 

Deep Head of F f lex. Brevis Pollicis- - 

Flexor Carpi Radialis J~ ~ 

Opponens Pollicis 



Extensor Brevis Pollicis -- 



Extensor Longus 

Poll. 
Flexor Longus Poll. 



^. Flexor Carpi Ulnaris 

Abductor Minimi Digiti 

-Adductor Obliquus Pollicis 



__Opponens Minimi Digiti 



Abductor M ini mi Digit! 

and Flexor Brevis 

Minimi Digiti 




Flexor Sublimis DigitorunUc 
Flexor Profundus Digitorum 



FIG. 5. BONES OF THE RIGHT HAND (ANTERIOR VIEW). 



and has a saddle-shaped base for articulation with the^rapezium. 
It supports only two phalanges. 

The second metacarpal is the longest, and the other three 
gradually decrease in length. They articulate with one another 
at their carpal ends, and with the trapezoid, os magnum, and 



JOINTS OF SHOULDER GIRDLE 15 

iinciform in order. Each of the four inner metacarpals supports 
three phalanges. 

The third metacarpal has a styloid process from its base on 
the radial side. 

Ossification. The four inner metacarpals have a primary 
centre for the shafts and bases developed before birth,* and the 
heads form a secondary epiphysis. The first metacarpal has the 
head and shaft formed from the primary centre and the base 
from the secondary centre. 

The Phalanges are fourteen in number, two on the first 
metacarpal and three each on the other four. The first 
phalanx is the largest of the three, the terminal ones being 
much smaller. They are short stout bones articulating with the 
metacarpals and one another. 

The terminal phalanges have flattened distal extremities to 
support the nails. 

Ossification. Similar to that of the first metacarpal bone. 

Sterno-Clavieular Joint, between the sternal end of the 
clavicle and the outer part of the upper edge of the sternum. 
A gliding joint, so only gliding movements possible. There 
are no movements round a distinct axis, but movements which 
depress or raise the scapula will cause the clavicle to move also, 
in both its joints. 

Ligaments. The joint is surrounded by a capsule attached to 
the edges of the articular surfaces of the bones, which is 
strengthened to form anterior and posterior ligaments. In. 
addition there is a meniscus, or disc of fibro-cartilage, between 
the two articular surfaces. 

Accessory Ligaments : Inter clavicular } attached to the sternal 
end of the clavicle and the suprasternal notch. It is continuous 
with the one of the other side. This ligament prevents the end 
of the clavicle being raised up too much when the acromial end 
is depressed as in carrying heavy weights. 

Rhomboid, attached to the under surface of the sternal end of 
the clavicle and the upper surface of the first costal cartilage ; 
it limits the movements of the clavicle when the arms are raised 
over the head. 

The synomal membrane lines the two joint cavities which are 
separated by the meniscus. 



16 



HANDBOOK OF ANATOMY 



Aeromio-Clavieular Joint, between the acromial end of the- 
clavicle and the acromion process of the scapula. 

A gliding joint similar in movement and function to the 
ster no-clavicular joint. The two joints give elasticity and 
increased movement tct the shoulder girdle. 

Ligaments. A capsule surrounds the joint, which is strength- 
ened to form superior and inferior ligaments. There is often a 
meniscus of fibro-cartilage to be found in this joint too, but not 
invariably. 

Accessory Ligaments: Coraco-clavicular between the acromial 
end of the clavicle and the coracoid process of the scapula. It 
is in two parts, viz. 

Conoid a triangular ligament attached by its apex to the 
upper surface of the coracoid process and by its base to the 
conoid tubercle of the clavicle. 

Trapezoid a ligament on the outer side of the conoid and 
attached to the upper surface of the coracoid process and to the 
oblique line from the conoid tubercle. 

MOVEMENTS OF SHOULDER GIRDLE TAKING PLACE AT STERNO- 
AND ACROMIO-CLAVICULAR JOINTS. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Eleva- 
tion 


Trapezius 
(upper 


Inner third superior 
curved line of occipital 


i 
Outer third of the pos- Spinal ac- 
terior surface of the cessory 




fibres) 


bone and external oc- 


clavicle ; inner border and nerves 






cipital protuberance 


of the acromion pro- 


from the 






from the ligamentum 
nuchae, the spine and 


cess, and the upper 
border of the spine of 


cervical 
plexus 






supraspinous liga- 


the scapula, and the 








ments of the seventh 


rough triangular sur- 






cervical, and all the 


face at the base of the 






thoracic vertebrae 


spine 




Levator 


Posterior tubercles of 


The upper fourth of the Cervical 




anguli 


the transverse pro- 


vertebral border of the plexus ; 




scapulae 


cesses of the upper 
cervical vertebrae be- 


scapula from the spine 
to the angle 


posterior 
scapular 






tween scalenus medius 










and splenius colli 








Rhom- 


Spines of the thoracic 


The vertebral border of Posterior 




boideus 


vertebrae, second to 


the scapula from the 1 scapular 




major 


fifth inclusive 


spine to the lower ! 








angle to a membranous 








band attached by the 










extremities 



MUSCLES OF SHOULDER GIRDLE 



17 



MOVEMENTS OF SHOULDER GIRDLE TAKING PLACE AT STERNO- 
AND ACROMIO-CLAVICULAR JOINTS Continued. 



Action 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Eleva- 


Rhom- 


Spines of seventh cer- 


The vertebral border of 


Posterior 


tion 


boideus 


vical and first thoracic 


the scapula opposite 


scapular - 




minor 


vertebrae 


the base of the spine 






Sterno- 


A narrow head from 


Outer surface of mastoid 


Spinal 




mastoid 


the anterior surface of process, and the outer 


accessory 






sternum, and also from half of the superior 


and cervica 






inner third of upper 


curved line of the oc- 


plexus 






surface of clavicle 


cipital bone 




Depres 


Trapezius 


See Elevation 






sion 


(lower 










fibres) 










Subclavius 


Upper surface of first 


Middle third of under 


Brachial 






costal cartilage 


surface of clavicle 


plexus 




Pectoralis 
minor 


EYom the anterior part 
of upper border of 
third, fourth, and 


Outer half of upper sur- 
face of coracoid process 


External 
and internal 
anterior 






fifth ribs and fascia 




thoracic 






covering them 








Latissimus 


From the spines of the 


The floor of the bi- 


Third sub 




dorsi 


lower six thoracic, 


cipital groove on the 


scapular 






and of all the lumbar 


humerus 








vertebras ; the pos- 




% 






terior part of the iliac 










crest , slips from the 








lower four ribs and 










the inferior angle of 










the scapula ; and deep 


< 








fascia covering back 








Pectoralis 


From the inner half of 


The outer lip of the 


External 




major 
(lower 


the anterior surface 
of the clavicle : from 


bicipital groove on 
the humerus 


and internal 
anterior 




fibres) half the anterior sur- 




thoracic 




face of the sternum in 










its whole length ; and 










from the cartilages of 










the upper six ribs 






For- 


Serratus 


From outer aspect of 


The ventral surface of 


Posterior 


wards 


magnus 


upper eight or nine 


the vertebral border 


thoracic 






ribs 


of the scapula in its 










whole length 






Pectoralis 


See Depression 








major 










Pectoralis 


See Depression 








minor 








Back- 


Trapezius 


See Depression 






wards 












Rhom- 


See Elevation 








boids 










IJatissimus 


See Depression 








dorsi 









18 



HANDBOOK OF ANATOMY 



Shoulder-Joint, between the head of the humerus and the 
glenoid cavity of the scapula. 

A ball-and-socket joint, permitting of particularly free move- 
ment as the socket is very shallow and much smaller than the 
ball. Movement can take place roiind three axes, viz. 
Transverse flexion and extension. 
Antero-posterior abduction and adduction. 
Vertical rotation in and out. 



Supraspinatus 



- Infraspinatus 



:^|E- vj-~ Teres Minor 




Teres Major * 

Tares Branch of Dorsalis 
Scapulae Artery 
Dorsalis Scapulae Artery \r 
Triangular Space 
Nerve to Teres Minor, wirh-" 
Gangliform Enlargement 



Posterior Circumflex Artery 
and Circumflex Nerve in 
Quadrangular Space 



- Pectoralis Major 



- - Deltoid 



FIG. 6. MUSCLES OF THE SHOULDER- JOINT. 

Ligaments. A capsule surrounds the joint attached to the 
anatomical neck of the humerus and the edge of the glenoid 
fossa outside the ligament. Inferiorly the attachment of the 
capsule runs down a little way 011 the shaft of the humerus. 



MUSCLES OF SHOULDER 



19 



The capsule is very loose, so that were it not for atmospheric 
pressure the humerus could be pulled at least an inch away 
from the scapula ; this adds to the mobility of the joint. 

Glenoid ligament,, a band of circular fibres round the edge of 
the glenoid fossa to deepen the socket.* 

Transverse humeral ligament bridges over the bicipital groove 
and allows the tendon of the biceps to pass under it. 

C Draco-humeral ligament between the root of the coracoid 
process and the upper surface of the head of the humerus. 

Gleno-humeral ligaments, three in number, from the anterior 
edge of the glenoid fossa to the anterior surface of the head of 
the humerus. 

All these ligaments are in reality part of the capsule. 

Accessory Ligaments : Coraco-acromial ligament, a strong band 
of fibres passing between the coracoid and acromion processes. 
This arches over the top of the joint and prevents dislocation 
upwards. 

The tendons of subscapularis, supra- and infra-spmatus are 
closely applied to the capsule of the joint as they near their 
insertions, so strengthening it; but it will be noticed that the 
joint is weak inf eriorly, having no strengthening ligaments in 
that aspect. 

The tendon of the biceps from the edge of the glenoid fossa ! 
passes through the joint over the head of the humerus, emerging 
from under the transverse ligament. 

The synovia! membrane is Very extensive, lining all the joint, j 
and is prolonged down on the tendon of the biceps. 

MUSCLES ACTJING ON THE JOINT. 



Action. Muscle. 


1 
Origin. 


Insertion. 


Nerve- 
supply. ' ; 


Flexion; Deltoid 
i (anterior 
fibres) 


! ' . 

Outer third of! anterior 
surface of ^clavicle ; 
outer border, of acro- 
mion process ; lower 
edge spine of 'scapula ; 
and deep fascia 


In a V-shaped impres- 
sion half-way down 
the outer surface of 
the humerus^ 


Circum- 
flex 


Pectoralis 


See Sterno - Cjlavicular 


Joint 




major 


I . 


- 





20 



HANDBOOK OF ANATOMY 

MUSCLES ACTING ON THE JOINT Continued. 



Action. 


Muscle. 


Origin. 


.nation. .-- 


Flexion 


Coraco- 


With short head of 


Into a rough linear Musculo- 


(con 


brachialis 


biceps from tip of 


impression half - way cutaneous 


tinned) 




coracoid process 


down the inner sur- 










face of the humerus 






Subsoapu- 
laris 


From the whole of the 
subscapular fossa and 


Lesser tuberosity of 
humerus and capsule 


First and 
third sub- 




the groove along the 


of shoulder-joint 


scapular 




axillary border, ex- 








cepting at the angles 








of the bone 






Biceps 


1. Short head from the 
tip of the coracoid 


Rough posterior por- 
tion of bicip'ital 


Musculo- 
cutaneous 






process with coraco- 
brachialis. 
2. Long head from > the 


tubercle of radius, and 
by a prolongation of 
the fascia of the deep 








edge of the glenoid 


fascia of the forearm 




fossa at the root of 


(see Bioipital Fascia, 




the coracoid process 


p. 37) 


Exten- Deltoid 


See Flexion 




sion (post-fibres) 






Teres major 


From the lower third of 


Inner lip of bicipital 


Second 




the axillary border of 


groove 


sub- 




the dorsum of the 




scapular ; 




scapula, and from deep 




nerve 






fascia 








Infra- 
spinatus 


From the infraspinous 
fossa and deep fascia 


The middle facet on Supra - 
the great tuberosity scapular 








of the humerus 






Latissimus 


See Sterno - Clavicular 


Joint 






dorsi 








Triceps 


1. Long head from a 


By one tendon inserted Musculo- 






rough surface on the 
axillary border of the 


on the posterior part spiral 
of the upper end of 






scapula just below the 


the olecranon process 








glenoid fossa. 


of the ulna 








2. Outer head from 








posterior surface of 








humerus between the 










musculo-spiral groove 
and the insertion of 










teres minor, a linear 










impression 








3. Inner head from the 






posterior surface of 








the humerus, from the 








musculo-spiral groove 








almost to the condyles 






and deep fascia 





ELBOW-JOINT 



21 



MUSCLES ACTING ON THE JOINT 



Action. 


Muscle. origin. Insertion. 


Nerve- 
supply. 


Abduc- 


Deltoid 


See Flexion 






tion 








Supra - 
spinatus 


From the supraspinous 
fossa and deep fascia 


To the uppermost facet 
on the great tuber- 
osity of the humerus 


Snpra- 
scapular 


Adduc- 


Pectoralis See Sterno - Clavicular 


Joint 




tion 


major 








Latissimus 


See Sterno -Clavicular Joint 






dorsi 










Teres major 


See Extension 








Coraco- 


See Flexion 








brachialis 






Biceps See Flexion 






(short head) 










Triceps 


See Extension 








(long head) 










Teres minor 


From the upper two- To the lowest facet on 


Circum- 






thirds of the axillary ; the great tuberosity 
border of the scapula of the humerus 


flex 




Weight of 


limb 




Rotation 


Infra- 


See Extension 




out 


spinatus 








Teres minor See Adduction 






Rotation 


Teres major 


See Extension 






in 








Pectoralis See Sterno -Clavicular 


Joint 






major 











Latissimus See Sterno - Clavicular Joint 






dorsi 




Circum duction a 


combination of all theseimovements 











The Elbow-Joint, between the trochlear and capitellar surfaces 
of the humerus, and the sigmoid fossa of the ulna and depression 
on the head of the radius. 

A hinge-joint permitting of movement round only one axis, viz. 

Transverse- flexion and extension. 

Ligaments. The capsular ligament is complete and strength- 



22 



HANDBOOK OF ANATOMY 



ened by various bands of fibres. It is attached to the upper 
borders of the fossae on the anterior and posterior surfaces of 
the humerus and the lower aspects of the condyles (not enclosing 
them in the joint cavity ) } round the margin of the olecranon pro- 
cess and the inner and anterior margin of the coronoid process, 
and round the lower edge of the articular surface surrounding 
the head of the radius i.e., just above the neck. It will thus be 



Orbicular Ligament 



Anterior Ligament 



.. Internal Epicondylcs 



Tendon of Biceps ..... 
{reflected) 




Brachialis Anticus 
(reflected) 



Oblique Ligament 



FIG. 7. THE ELBOW- JOINT. 

seen that the elbow-joint encloses within its cavity the superior 
radio-ulnar joint. 

Anterior Ligament, from the upper margins of the coronoid 
and supracapitellar fossa? on the humerus to the margin of the 
coronoid process and the orbicular ligament of the radio-ulnar 
joint. The fibres of this ligament are arranged in several 
directions to give strength. 

Posterior Ligament, from the upper margin of the olecranon 



RADIO-ULNAR JOINTS 



23 



fossa of the humerus to the anterior margin of the upper aspect 
of the olecranon process of the ulna. 

Internal Lateral Ligament is arranged in three parts, forming 
a triangle : (1) From anterior border of inner condyle to the 
margin of the coronoid process; (2) from the inferior and 
posterior border of the condyle to the olecranon process ; ami 
(3) from the olecranon process to the coronoid process. 

External Lateral Ligament, from the lower border of the outer 
condyle of the humerus to the orbicular ligament on the radius. 

MUSCLES ACTING ON THE ELBOW-JOINT. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve- 
supply. 


Flexion 


Biceps 


See Shoulder-Joint 








Brachialis 
anticus 


From lower two-thirds 
of anterior surface of 
shaft of humerus and 
the intermuscular 
septa, enclosing above 
the insertion of the 
deltoid 


The rough tubercle on 
the anterior surface 
of the coronoid pro- 
cess of the ulna and 
the anterior ligament 
of the elbow-joint 


Musculo- 
cuta- 
neus 




Brachio- 
radialis 


See Radio-Ulnar Joints 








Pronator 
radii teres 


See Radio-Ulnar Joints 








Flexors of 
wrist and 
fingers 


See Wrist and Phalang 


eal Joints 







Extensors of 
wrist (during 
pronation) 


See Wrist and Phalang 


eal Joints 




Exten- 
sion 


Triceps 


See Shoulder- Joint 








Anconeus 


From posterior surface 
of outer condyle of 
humerus 


The outer surface of 
olecranon process, 
back of ulna and deep 
fascia 


Musculo- 
spiral 




Extensors of 


wrist and fingers during 


supination 





Cartilage covers the articular surfaces of the joint as usual, 
but is not prolonged into the fossae on the humerus, where pads 
of fat are placed. There is also a narrow gap in the cartilage 



24 



HANDBOOK OF ANATOMY 



covering the surfaces of the olecranon and coroiioid processes, 
thus separating the two. 

The synovial membrane lines all the joint, including those 
parts not covered by cartilage, and is continuous with that 
lining the superior radio-ulnar joint. 

The Radio-Ulnar Joints, between the extremities of the 
opposing surfaces of the radius and ulna. These joints are 



Clavicular part of Pectoralis Major 
Clavicular part of Deltoid x 

Coraco-brachialis 



Sterno-costal part 
of Pectoralis 
Major 




Latissimus Dorsi and 
Teres Major 

Biceps. 
Long Head of Triceps 

Brachialis Anticus. 



Supinaior Radii 

Brevis 
Brachio-radialis 



Obliquus Ext Abdominis 
Serratus Magnus 

Internal Head of Triceps 



--.Brachialis Anticus 
..Pronator Radii Teres 

-Flexor Carpi Radia'is 
Palmaris Loneus 
Flexor Carpi Ulnaris 



FIG. 8. MUSCLES OF THE UPPER ARM. 

both gliding joints, and by their means the radius is enabled to 
turn round on the ulna, causing pronation and supination of the 
hand. (Pronation = palm downwards ; supination = palm upwards.) 

Superior Radio-Ulnar Joint, between the head of the radius 
and the radial notch on the outer surface of the ulna. 

Ligaments. Orbicular ligament, a ring of strong tendinous 
fibres attached to the extremities of the radial notch on the ulna 



MUSCLES OF FOREARM 



25 



and encircling the head of the radius; the lower edge of the 
ring is smaller than the upper, so that the radius is as it were 
suspended by its head. 

Accessory Ligament : Oblique ligament, a thin band from the 
outer surface of the coronoid process of the ulna to the radius, 
where it is attached just below the bicipital tuberosity. 

The synovial membrane lines the joint, and is continuous with 
that of the elbow-joint. 

Inferior Radio-Ulnar Joint, between the inner surface of the 
inferior end of the radius and the outer surface of the inferior 
end of the ulna; the inferior surface of the lower end of the 
ulna is also included in the joint by means of the articular disc 
of cartilage which excludes the ulna from the wrist-joint. 

MUSCLES ACTING ON THE RADIO-ULNAR JOINTS. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Supina- 
tion 


BracLio- 
radialis 


From the upper two- 
thirds of the external 


The styloid process of 
the radius 


Musculo- 
spiral 




(snpinator 


supracondyloid ridge 








longus) 


of the humems 








Supinator 


From the external con- 


The upper part of the 


Posterior 




brevis 


dyle of the hum eras ; 


shaft of the radius, ! interosseous 






the external lateral 


reaching from the 








and orbicular liga- 


neck to the oblique 








ments ; the triangular 


line, and from the 








surface of the ulna 


anterior border of 








just below the radial 
notch and the deep 


the bicipital tubercle 
round to the posterior 








fascia 


border 




Prona- 
tion 


Pronator 
radii 


From the common 
flexor tendon on the 


The rough oval impres- 
sion half-way down 


Median 




teres 


internal condyle of the 


the outer surface of 








humerus, the lower 


the shaft of the 








part of the ridge above 


radius 








the inter -muscular 










septa and the deep 










fascia, and a slip from 










the inner side of the 










coronoid process of the 










ulna 








Pronator 


From the lower fourth 


The outer border of 


Anterior 




quadratiis 


of the ventral surface 


the lower fourth of 


interosseous 






of the ulna 


the ventral surface 










of the radius 





26 HANDBOOK OF ANATOMY 

The Triangular Mbro- Cartilage separates the two joints ; it is. 
attached by its apex to the outer surface of the styloid process 
of the ulna, and by its base to the edge of the inner surface of 
the lower end of the radius below its articulation with the 
ulna. 

Ligaments. The capsule is very imperfect, consisting of a few 
transverse fibres which* connect the bones ventrally and dorsally. 

The synovial membrane lines the joint and passes over the 
.upper surface of the triangular fibro-cartilage. 

The Interosseous Membrane is a strong fibrous membrane 
stretched between the radius and ulna, and attached to their 
inter osseous borders. Above, it extends to within about an inch 
of the head of the radius, leaving a gap for the passage of the 
dorsal inter osseous vessels ; below, it reaches down to the ex- 
tremities of the bones. The direction of the fibres is downwards 
from the radius to the ulna. 

The Wrist (Radio-Carpal) Joint between the distal end of the 
radius and the triangular fibro-cartilage, and the proximal row 
of carpal bones. 

The joint is a condyloid one, capable of movement through 
two axes : 

Antero-posterior flexion and extension. 

Transverse abduction and adduction. 

In the ordinary position of the hand the end of the radius and 
articular disc are in contact with the scaphoid and semilunar 
bones, but in adduction (the hand bent to the ulnar side) the 
cuneiform bone is pushed outward and comes in contact with 
the triangular fibro-cartilage instead of the capsule of the joint. 

Ligaments. A capsule completely surrounds the joint, and is 
attached to the edges of the articular surfaces, and is carried up 
to the edge of the lower end and styloid process of the ulna. It 
has well-defined strengthened portions. 

Anterior Carpal ligament, attached above, to the lower edge 
of the radius, the styloid process of the ulna, and the anterior 
border of the triangular fibro-cartilage; below, to the palmar 
surfaces of the scaphoid, semilunar, and cuneiform bones. Some 
fibres may be carried on to the os magnum. 

Posterior-carpal ligament, attached above to the lower end of 



MUSCLES OF FOREARM 



27' 



Triceps 



Anconeus 

Extensor Communis 
Digitorum 



Extensor Minimi Digiti- 
Extensor Carpi Ulnaris- 



Dorsal Branch of 
Ulnar Nerve 

Posterior Annular 
Ligament 



Extensor Minimi Digit 
(in two parts) 




Biceps 



Brachio-radialis 

Extensor Carpi Radialis Longiov 
Extensor Carpi Radialis Brevior 
Supinator Radii Brevis 

Posterior Interosseous Nerve 



Extensor Ossis Metacarpi 
Pollicis 



Extensor Brevis Pollicis 

Radial Nerve 

Extensor Longus Pollicis 

Extensor Indicis 



; Extensor Brevis Pollicis 

;. 



Extensor Indicis 

._ Extensor Longus Pollicis. 



FIG. 9. MUSCLES OF THE FOREARM (DORSAL ASPECT). 



28 HANDBOOK OF ANATOMY 

the radius and below to the dorsal surfaces of the proximal row 
of bones. 

Internal Lateral ligament, attached above to the styloid process 
of the ulna, and below to the ulnar side of the cuneiform and 
pisiform bones. 

External Lateral ligament, attached above to the styloid pro- 
cess of the radius, and below to the tubercle of the scaphoid. 

The synovial membrane completely lines the joint cavity, and 
may be continuous with that of the inferior radio-ulnar joint if 
the articular disc be perforated. 

The Interearpal Joints between the bones of the carpus are 
all gliding joints, and they have numerous ligaments between 
the adjacent bones ; in addition to this, the carpus is surrounded 
by a complete capsule. 

The synoviaf membrane lines the joint, and may have a 
separate division for the articulation between the cuneiform 
and pisiform bones. 

Muscles acting" on the Joint. These both ventrally and 
dorsally are arranged in two sets, superficial and deep ; on the 
flexor (ventral) surface, the superficial group comes from the 
inner condyle of the humerus, and the deep ones from the 
ventral surfaces of the ulna and radius ; on the extensor (dorsal) 
surface the superficial group comes from the outer condyle of the 
humerus, and the deep ones from the dorsal surfaces of the ulna 
and radius. Thus both superficial groups act on the elbow- 
joint. 

The Carpo-Metacarpal Joints, between the five metatarsal 
bones and the distal row of carpal bones; the first metatarsal 
bone articulates with the trapezium, and the four inner meta- 
tarsals articulate with the other three bones. 

First Carpo-Metaearpal Joint, between the base of the first 
metacarpal bone and the distal surface of the trapezium. The 
articulating surfaces of the joint are saddle-shaped, so that 
movements occur round three axes. 

Transverse flexion and extension. 

Antero-posterior abduction and adduction (to middle line 
of hand). 

Longitudinal rotation. 



MUSCLES OF FOREARM 



Although this is not a ball-and-socket joint, a certain amount 
of circumduction is possible, and the movement of opposition i.e. 
bringing the thumb right across the hand is due to a combina- 
tion of flexion, adduction, and rotation. 

Ligaments. A capsule surrounds the joint which has strength- 
ening bands in it, forming four ligaments. 

The synovial membrane lines the joint, which is quite separate 
and distinct. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Flexion 


Flexor 


From common tendon 


Palmar surfaces of base ; Median 




carpi 


on inner condyle of 


of second metacarpal 






radialis 


humerus and deep 


bone and a small slip 








fascia 


to third metacarpal 




' Palmaris 


From common tendon 


Surface of anterior an- Median 




longus 


and deep fascia 


nular ligament and 








central part of palmar 










fascia 






: Flexor 


From common tendon 


To the pisiform bone, 


Ulnar 




carpi 


on inner condyle and 


and continued on to 






ulnaris 


deep fascia, the inner 


the hook of the unci- 








border of the olecra- 


form and the base of 








non process, and the 


the fifth metatarsal 








upper three-fifths of 










the posterior border 










of the ulna 








Flexor 


From the common flexor 


The muscle divides into 


Median 




sublimis 


tendon ; the internal 


four tendons ; these 






digitorum 


lateral ligament of 
the elbow-joint and 


split to allow the 
tendon of flexor pro- 









deep fascia ; the inner 


fundus digitorum to 








border of coronoid 


pass through, and, 








process of ulna (above 


after uniting again, 








that of pronator 


each tendon divides 








radii t ore's).; the 


into two parts to be 








oblique line of the 


inserted into the sides 








radius 


of the second phal- 






* 




anges of the four inner 










metatarsals 




Flexor 


From the upper two- 


The muscle divides into Ulnar and 




profundus 


thirds of the anterior 


four tendons, each of anterior 




digitorum 


and internal surfaces 
of the ulna up to the 


which passes through 
the corresponding 


interosseous 
(median) 






inner surface of the 


tendon of flexor sub- 








olecranon process; 


limis digitorum to be 








inner half of middle 


inserted in the bases 








third of the inter- 


of the terminal phal- 








osseous membrane and 


anges of the four inner 








deep fascia 


metatarsals (see Lum- 










bricales) 





30 



HANDBOOK OF ANATOMY 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Flexion 


Flexor 


From the middle'half of 


The palmar surface of 


Anterior 


(contd.) 


longvis 


the anterior surface of 


the base of the ter- 


interosseous 




pollicis 


the shaft of the radius 


minal phalanx of the 








and the correspond- 
ing half of the inter- 


thumb 








osseous membrane 






Exten- 


Extensor 


From the ventral sur- The dorsal surface of 


Musculo- 


sion 


carpi 


face of the lower third the base of the second spiral 




radialis 
longior 


of the outer supra- 
condyloid ridge of the 


metacarpal bone 






humerus, the inter- 










muscular septum, and 










the common extensor 









tendon on the outer 








condyle 


1 




Extensor 


From the common 


The dorsal surface of; Posterior 




carpi 


extensor tendon, the 


the base of the third 


intejrosseous 




radialis 


external lateral liga- 


metacarpal bone 






brevior 


ment of the elbow- 










joint and deep fascia 








Extensor 


From the common 


The muscle divides into 


Posterior 




communis 


extensor tendon and 


four tendons, to be 


mtefosseous 


1 


digitorum 


deep fascia inserted in the four 








inner digits. Each 










one passes down the 


j 


: 






back of the hand and 




, 






spreads out over the 










knuckle ; it then 










divides into three 


: 








slips the middle one 










is inserted into the 


1 








base of the second 










phalanx, and the side 










ones join together to 










be inserted into the 










base of the terminal 











phalanx 






Extensor 


From the common Into the .expansion of 


Posterior 




minimi 


extensor tendon and 1 the extensor tendon 


interosseous 




digiti 


deep fascia on the back of the 








first phalanx of the 








: little finger 






Extensor 


From the common ! The ulnar side of the 


Posterior 




carpi 


tendon and i deep i base of the fifth meta- 


interosseous 




ulnaris 


fascia and middle half 


carpal bone 








of the posterior border 










of the ulna 








Extensor 


From the upper half of ' The radial side of the 


Posterior 




ossis 


the outer surface of the base of the first meta- 


interosseous 




metacarpi 


ulna ; the middle third carpal 






pollicis 


of the dorsal surface of 










the radius and inter- 










osseous membrane 




' 



JOINTS OF HAND 



Action. 


Muscle. 


Origin. 


Insertion. 

The dorsal surface of 
the base of the first 
phalanx of the thumb 


Nerve-supply. 


Exten- 
sion 
(contd. ) 


Extensor 
brevis 
pollicis 


From the dorsal surface 
of the radius below 
extensor ossis meta- 
carpi pollicis and 
the interosseous mem- 
brane 


Posterior 
interosseus 




Extensor 
longus 
pollicis 


From the middle third 
of the dorsal surface 
of the ulna and the 
interosseous m e m- 
brane below exten- 
sor ossis metacarpi 
pollicis 


The dorsal surface of 
the base of the second 
phalanx of the thumb 


Posterior 
interosseous 




Extensor 
indicis 


From the dorsal surface 
of the ulna below 
extensor longus polli- 
cis and from the inter- 
osseous membrane 


The expansion of the 
tendon of extensor 
communis digitorum 
on the first finger 


Posterior 
interosseous 


Abduc- 
tion 


Flexor 
carpi 
radialis 


See Flexion 








Extensors 


See Extension 








carpi 
radialis 
longior 
and 
brevior 


- 








Extensors 
of thumb 


See Extension 






Adduc- 


Flexor 


See Flexion 






tion 


carpi 
ulnaris 










Extensor 


See Extension 








carpi 
ulnaris 









The other carpo-metacarpal joints are formed between the 
bases of the four inner metacarpals and the trapezoid, os magnum, 
and unciform. They are freely moving gliding joints. 

Ligament. A common capsule surrounds all four joints, which 
includes also the intermetacarpal joints. There are numerous 
interosseous ligaments binding* them all together. 

A synovial membrane lines all the joint cavities, which com- 
municate with one another. 

Metaearpo-Phalang-eal Joints are between the heads of the 
inetacarpal bones and the bases of the first phalanges. 



32 



HANDBOOK OF ANATOMY 



The first one differs from the rest in being a hinge-joint ; the 
others are modified ball-and-socket, so that movement takes 
place round two axes : 

Transverse flexion and extension. 

Antero-posterior abduction and adduction. 



Flexor Carpi Ulnaris - 

Flexor Sublimis Digitcrum f j r 



Anterior Annular ^_ 

Ligament 



Abductor Minimi 

Digiti 

Flexor Brevis Minimi. 

Digiti 

Opponens Minimi 

Digiti 



3rd Palmar Inteross. 

4th Dorsal Inteross. 

2nd Palmar Inteross 

3rd Dorsal Inteross.*"" 
and Dorsal Inteross., 



Flexor Carpi Radialis 
Flexor Longus Pollicis 

NJr. Abductor Pollicis (cut) 

Opponens Pollicis 




. Superficial Head of Fiercer 
Brevis Pollicib 

Add. Obliquus 
Pollicis 

Add. Trans. 
Pollios 

XAbductor 
Pollicis (cut) 

-- Flexor Longus 
Pollicis 

-~.ist Dors.. I 
Interosscons 

-^ist Palmar 
Interosseo.is 



^-.ist Lumbricalis 



FIG. 10. MUSCLES OF THE HAND (PALMAR ASPECT). 

Ligaments. A capsule, completely surrounds each joint, which 
is very much weaker on the dorsal surface, where the joint is 
strengthened by the expansion of the extensor tendon. 

Ulnar and Radial Lateral ligaments, strong cord-like bands 



MUSCLES OF THUMB 33 

attached to the tubercles on the sides of the heads ot the 
metacarpal bones and the bases of the phalanges. 

The Palmar ligaments are plates of fibre-cartilage attached 
firmly to the phalanges, but only loosely to the metacarpals, so 
that during movements of the joints they can glide up ancL 
down. In this plate two sesamoid bones are developed in the 
thumb, and one on the radial side of the forefinger. 

Synovial membrane lines the capsule of each joint. 

Transverse Metacarpal ligament consists of bands of transverse 
fibres, which connect the palmar ligaments of the four inner 
metacarpo-phalangeal joints. This binds together the distal 
-extremities of the bones. 

Interphalang-eal Joints. These joints are all hinge-joints, 
.allowing movements round one axis only : 

Transverse flexion and extension. 

Their ligaments and synovial membrane are similar to those 
of the metacarpo-phalangeal joints. 

MUSCLES ACTING ON THE JOINTS. 

FIRST METACARPO-PHALAXGEAL AXD INTERPHALANGEAL JOINT. 



Action. 


Muscle. 


Origin. Insertion.' 


Nerve-supply. 


Flexion 


Flexor 


See Wrist-Joint 






lougus 








pollicis 








Flexor 


1. Radial half lower Radial side base of 


Median 




brevis 


border anterior annu- first phalanx 






pollicis 


lar ligament and the 








ridge on the trape- 








zium 








2. Ulnar side of base of Ulnar side of base of 


Ulnar 






first metacarpal first phalanx 






Abductor 


From the tubercle of The radial side of the 


Median 




brevis 


the scaphoid, the base of the first 






pollicis 


ridge of the trape- phalanx and the cap- 








ziimi, the radial part sale of the joint 








of the anterior surface 








of the annular liga- 








ment 






Opponens 


From the ridge on the The whole of the radial 


Median 




pollicis 


trapezium and the ; border and the radial 








anterior surface of the half of the palmar 








annular ligament surface of the first 








metacarpal 





HANDBOOK OK ANATOMY 



KIKST MKTACAKl'O-IMIALANCJKAL AND INTERPHALAHGEAL 

.10 1 NT Conti.nu.l. 



Aetion. 


Muacla. 


Origin. lino,rti"n. 


Nerve-supply. 




Adductor 


From the palmar snr- The ulnar side of the 


Ulnar 




obliquus 


faces of the os trape- 


base of the first 






pollicis 


y.ium and trapexoid, 


phalanx 








the OS magnum and 








bases of the second, 










third, and fourth 








Adductor 


From the lower two- 


'The ulnar side of the 


Ulnar 




trans- 


thirds of the median 


base of the first 






versns 


rid^e on the palmar 


phalanx 






pollicis 


surface of the third 










mctacarpal 






Exten- 


Abductor 


See Wrist -Join! 






sion 


longus 
pollicis 










Extensor 


See Wrist-Joint 








longus 










pollicis 










Extensor 


See Wrist-Joint 








brevis 










pollicis 








Adduc- 


Adductor 


See Flexion 






tion 


obliquus 










pollicis 










Adductor 


See Flexion 








trans- 










vorsus 










pollicis 










Flexor 


See Flexion 








brevis 










pollicis 










Opponens 


See Flexion 








pollicis 










First 


From the adjacent sides 


The radial side of the 


1' nar 




dorsal 


of the first and second 


index -finger on the 






inter- 


metacarpal bones 


dorsal expansion of 






osseous 




the extensor tendon, 










the capsule of the 










nietacarpo-phalan^'eal 










joint and the side of 










the first phalanx 




Abdno- 


Abductor 


See Flexion 






tion 


brevis 










pollicis 










Abductor 


See Wrist-Joint 








lOlltfUS 

pollicis 










Extensors 


See Wrist-Joint 








of thumb 






:n dnotion an 


I rotation are carried on 


t by a combination ofthel.se muscles 



MUSCLES OF FINGERS 



35 



KETAOARPO AND INTERPHALANGEAL JOINTS OF FOUR 
INNER DIGITS. 



Action. 


MuHde. 


Origin. 


Insertion. 


Nerve-supply. 


Flexion 


Flexor 


See Wrist-Joint 




- 




subliinis 










digitorum 










Flexor 


See Wrist- Joint 








profundus 










digitorum 










Lunibri- 


Four muscles arising 








cales 


from the tendons of 










Hexor profundus digit- 










orum 








Two radial 


From theradial sides of 


Similar to the dorsal 


Median 




ones 


the tendons for the 


interosseous muscle. 








index and middle 


See Thumb-Joints 








fingers 








Two ulnai 
ones 


From the adjacent sides 
of the second and 


Similar to the dorsal 
interosseous muscle. 


Ulnar 






third, and third and 


See Thumb-Joints 








fourth tendons 








Interossei 


Three ; the first from 


Ditto 


Ulnar 




palmar 


the ulnar side of the 










second rnetacarpal, 










the two others from 










the radial side of the 










fourth and fifth meta- 










carpals respectively 








Dorsal 


Four, each arising from 


Ditto 


Ulnar 






the adjacent sides of 










the metacarpal bone 






(in lie' 


fifthfinger 


only : 








Flexor 


From ulnar part of 


Ulnar side of base of 


Ulnar 




brevis 


anterior surface of 


first phalanx of little 






niininii 


annular ligament and 


finger 






digiti 


hook of unciform 






Exten- 


Extensor 


Sei- Wrist-Joint 






sion 


communis 










digitorum 










Extensor 


See Wrist- Joint 








indicis 










Extensor 


See Wrist-Joint 








minimi 










digiti 










Lumbri- 


See Flexion 








calcs 










Inti-rossci 


See Flexion 







36 



HANDBOOK OF ANATOMY 



METACARPO AND INTERPHALANGEAL JOINTS OF FOUR 
INNER DIGITS Continued. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Abducti 


on from the 


ulnar side of the liand 








Lumbri- 


See Flexion 








cales 










Flexor 


See Flexion 








brevis 










miiiimi 










digiti 








Opponens 
minimi 


Similar to flexor brevis 
minimi digiti 


The lower three-fourths 
of the ulnar margin 


Ulnar 




digiti 




and palmar surface of 








the fifth metacarpal 




From 


the middle 


line of the middle finger: 








Dorsal 


See Flexion 








interossei 










Abductor 


From the palmar sur- 


Ulnar side of base of I Ulnar 




minimi 


face of the pisiform 


first phalanx of little 






digiti 


bone 


finger 




Adducti 


on to the 


middle line of the middle 


finger 






Palmar 


See Flexion 




i 1 




interossei 









The Deep Fascia of the shoulder and upper limb is attached 
to the clavicle, acrornion, and spine of scapula. It encases all 
the muscles, and is continuous with the deep fascia of the back 
and the axilla ; it is then continued down the arm,, covering all 
the muscles, and at the elbow sends in processes called inter- 
muscular septa, which separate the muscles of the front of the 
arm from those of the back, also affording additional surface for 
the origins of muscles. In front of the elbow it is attached to 
the condyles of the humerus and olecranon process of the ulna, 
and covers in the antecubital fossa, and receives a crescent- 
shaped expansion from the tendon of the biceps called the 
bicipital fascia ; it is continued down the forearm, closely invest- 
ing the muscles and sending septa between them. At the wrist, 
on both dorsal and ventral surfaces, there are bands of strong 
transverse fibres to hold down the tendons, called respectively, 
posterior and anterior annular ligaments of the wrist-joint. 
The deep fascia then invests the muscles of the hand forming 
anteriorly a particularly strong triangular piece the palmar 
fascia which sends four processes to be inserted into the digital 
sheaths. 



DEEP FASCIA . 37 

Costo- Coracoid Membrane, a process of the deepjfascia cover' 
ing pectoralis minor, which, after splitting to enclose subclavius, 
becomes attached to the first costal cartilage and the coracoid 
process. The membrane itself is thin and pierced by superficial 
vessels, but the piece between the costal cartilage and coracoid 
process is much stronger, and is called the costo-coracoid liga- 
ment. 

Axillary Fascia, a particularly strong fascia forming the floor 
of the axillary space, from the edge of the pectoralis major in 
front to the latissimus dorsi and teres major behind ; it is con^ 
tinuous with the deep fascia of the arm. 

Bicipital Fascia, a strong band of fascia from the tendon of 
the biceps, which joins the deep fascia covering the front of the 
elbow. It separates the brachial artery from the median basilic 
vein. 

Anterior annular ligament, a band of transverse fibres in the 
deep fascia attached on the ulnar side to the pisiform bone and 
the hook of the unciform, and on the radial side to the scaphoid 
and trapezium. It bridges across the concavity of the carpus 
and holds the flexor tendons in place. All the tendons pass 
under it, except palmaris longus and flexor carpi radialis, the 
latter piercing the ligament to reach its insertion. The ulnar 
artery and nerve cross over the ligament". 

Posterior annular ligament, a 'transverse band of fibres in the 
deep fascia, attached to tne external border of the lower end of 
the radius, and the internal border of the lower end of the ulna. 
This is a much weaker and less important band than the anterior 
one. All the tendons pass underneath it, the ulnar and radial 
nerves passing over it. 

The fascia is divided underneath into six compartments for 
the passage of the tendons, which lie in grooves in the bone. 

1 . Extensor ossis metacarpi "1 . 

. . in the nrst groove on the ex- 

pollicis . ... e ... 

,,_: . ,,. . ternal side of the radius. 

Jbxtensor brevis pollicis J 

2 . Extensor carpi radiales, } . 

un the second groove, 
longior and brevior 

3. Extensor longus pollicis in the third groove. 



38 HANDBOOK OF ANATOMY 

4. Extens<jr communis digi-^j 

torum Vin the fourth groove. 

Extensor indicis 

5. Extensor minimi digiti in the groove between the ulna and 

radius. 

6. Extensor carpi ulnaris in the groove of the ulna. 

Digital Sheaths, strong fibrous sheaths which hold down the 
flexor tendon of the fingers. They are attached along the edges 
of the palmar surfaces of the phalanges and interphalangeal 
joints, and continuous with the palmar fascia. 

The Axilla is the hollow space in the armpit through which 
the axillary vessels and the cords of the brachial plexus pass to 
reach the arm. It is cone-shaped, with the apex upwards. 

The apex is bounded by the superior border of the scapula, 
the first rib, and the clavicle, and is covered in by the costo- 
coracoid membrane. 

The floor is formed of the deep fascia. 

The posterior wall is formed by subscapularis, teres minor, 
teres major, and latissimus dorsi, the lower free edge of which 
is called the posterior fold. 

The anterior wall is formed by pectoralis major, the lower free 
edge of which is called the anterior fold. 

The inner wall is formed by the upper digitations of the 
serratus magnus. The outer wall is formed by the long head of 
triceps and the humerus. 

The contents are the axillary vessels, the cords of the brachial 
plexus with their branches, some lymphatic glands and fat. 

The Antecubital Fossa is the triangular space in front of the 
elbow-joint, covered in by deep fascia and the bicipital fascia. 
Its boundaries are, above, a line drawn between the condyles of 
the humerus, on the inner side pronator radii teres, and on the 
outer side brachio-radialis. 

In the fossa the brachial artery breaks up into its branches. 



SECTION III 
PELVIC GIRDLE AND LOWER LIMB 

THE pelvic girdle consists of three bones firmly joined together, 
with two of which the two femurs articulate by means of ball- 
and-socket joints ; the pelvic girdle and lower limb are analogous 
to the shoulder girdle and upper limbs (see comparison in 
Section I.). 

The bones forming the pelvis are the two innominate bones, 
joined together in front at the symphysis pubis and articulating 
with the sacrum behind. 

The Innominate Bone is a large, flat irregular-shaped bone 
-consisting of three parts, which at birth are distinct, but in 
adult life become fused together in the same way that epiphyses 
fuse with the shafts in long bones. The three parts are re- 
spectively the ilium, ischium, and pubis, which join together to 
form the acetabulum, a deep socket which receives the head of 
the femur. 

The Ilium forms a fan-shaped expansion, the top edge of 
which, the crest of the ilium, is thickened to give attachment to 
muscles. About two inches from the anterior end is a rough 
tubercle, which is the highest point of the crest, and can easily 
be felt in the living subject. The crest forms an S- shaped curve, 
the anterior half being convex outwards. The ends are termed 
respectively the anterior and posterior superior spines. The 
anterior margin of the ilium extends from the anterior superior 
spine to the margin of the acetabulum, of which the ilium forms 
the upper two-fifths. Halfway down the anterior margin is a 
rough tubercle called the anterior inferior spine. 

The posterior margin extends from the posterior superior 
spine to the posterior margin of the acetabulum. A little way 

39 



40 



HANDBOOK OF ANATOMY 



below the spine is another tubercle, called the posterior inferior 
spine ; from this the edge of the bone curves sharply forwards, 
forming the great sciatic notch. 

The ilium has two surfaces internal and external. The 
external one is sometimes termed the glutealj as it has three 



'1 ransversalis Abdommis 
Obliquus Interims Abdominis, X 
Middle Gluteal Line 



Crest 



Obliquus Externus Abdominis 



Latissimus Dors! 
Superior Gluteal Line 



Posterior Superior.- 
Iliac Spine 

Posterior Inferior 
Iliac Spine 




Great Sciatic Notch - 



Isch:al Spine 
Gemellus Superior 
Snail Sciitic Notch - 
Gemelius Inferior" 
Obturator Groove 

Semimembranosus 
^miterdinostis and Long Head 
Biceps 

Tuber Ischi 



Adductor Mag 



.Tensor Fasciae 
Femoris 



Anterior Superior 

Iliac Spine 
-Inferior Gluteal Line 

Anterior Inferior Spine 
and Straight Head of 
Rectus Femoris 



,-Acetabulum 



,.Cotyloid Notch 

, Pubic Spine 
f Pubic Crest and 

Rectus Ahdominis 
._ Pubic Angle 
,, Adductor Longus 
Symphysis Pubis 

>Gracilis 



escending Pubic Ramus 
N Adductor Magnus 

ischial Ramus 



FIG. 11. INNOMINATE BONE. 



well-marked ridges superior, middle, and inferior which limit 
the origins of the gluteal muscles. The internal surface of the 
bone is divided into two parts the posterior part, which takes 
up nearly half, is a rough auricular -shaped surface for 
articulation with the sacrum ; while the anterior part, which is 



PELVIC BONES . 4t 

smooth, has a sharp well-defined oblique ridge, the ilio-pectineal 
line, from the auricular surface to the front of the bone. This 
marks the line of fusion with the pubis, and also divides the 
true pelvis from the false pelvis. Above the ilio-pectineal line 
the bone forms the shallow iliac fossa. 

The Ischium consists of a body and two rami superior and 
inferior. The body forms the inferior and posterior two-fifths 
of the acetabulum, and from the posterior border of the body 
projects a sharp spine the ischial spine. From the body the 
superior ramus passes downwards and back, and from its inferior 
extremity the inferior ramus passes forwards at an acute angle, 
to join the inferior ramus of the pubis. The angle of the two 
ischial rami forms a large tubercle the tuberosity of the 
ischium and between this and the ischial spine above, the 
edge of the bone is curved forwards to form the small sciatic 
notch. 

The Pubis consists of a small triangular body with two rami 
superior and inferior. The superior ramus completes the re- 
maining one-fifth of the acetabulum, and the inferior ramus 
passes backwards to join the inferior ramus of the ischium, thus 
enclosing the obturator, or thyroid foramen. The upper part of 
the body projects forwards to form the crest of the pubis, which 
externally ends in a small spine or tubercle which joins the ilio- 
pectineal line. The inner border of the body consists of a long,, 
narrow, oval surface which articulates with its fellow of the 
opposite side by means of an intermediate disc of cartilage. 

The Acetabulum is practically half a sphere, and is directed 
downwards and forwards. It has a sharp, well-defined margin, 
which is interrupted infer iorly, forming the cotyloid notch. 

Ossification. At birth there are three primary centres, one in 
each bone. Afterwards secondary centres appear for the ischial 
tuberosity and spine, and inner part of the body of the pubis. 
The whole bone is usually fused together by the twenty-fifth year. 

The Sacrum, articulating with the innominate bones, completes 
the pelvis. (For description of sacrum, see the Vertebrae, in. 
Section IV.) 

The Pelvis is divided into two parts by the ilio-pectineal line, 
which extends from the sacro-iliac joint behind to the spine of 



42 



HANDBOOK OF ANATOMY 



the pubis in front. The part above this line is called the false 
pelvis; the part below, the true pelvis. 

The false pelvis is bounded by the expanded wings of the 
ilium and the upper part of the sacrum, and supports the 
abdominal contents. The true pelvis is much smaller, and is 
bounded above by the ilio-pectineal lines and the upper margin 
of the pubis, and its walls are formed by the lower part of the 
sacrum, the bodies and rami of the ischium and pubis. 

Differences between Male and Female Pelvis. The upper 
margin of the true pelvis is often called the brim, or inlet, of 




Acetabulum 



Symphysis 
Pubis 

FIG. 12. PELVIS. 



the pelvis. This is heart-shaped in the male and oval in the 
female owing to the shape of the upper part of the sacrum, 
Avhich in the male is more prominent. 

The angle formed by the bodies of the two pubic bones at the 
symphysis i.e., the pubic arch is a right angle in the female 
and an acute angle in the male. The ischial spines are turned 
inwards in the male and project straight from the ischium in 
the female. 

The coccyx is turned forwards in the male and as a rule 
firmly joined to the sacrum. In the female it is straighter and 
has a movable joint. 



BONES OF LOWER LIMB 43 

From these differences it will be seen that the true pelvis is 
altogether more roomy in the female and the outlet wider, which 
is necessary for the purposes of childbirth. 

The Femur is a long bone with a shaft, and two extremities. 
It articulates above with the acetabulum of the os innominatum 
and below with the head of the tibia and the patella. 

The Upper Extremity consists of a rounded head forming 
half a sphere, which is joined to the shaft, at an angle of 127*5 
degrees, by the neck, a stout bar of bone, an inch or more in 
length. The cartilage-covered part of the head has a wavy 
outline where it joins the neck, and just below the summit is a 
small fossa for the insertion of the ligamentum teres. The two 
trochanters of the femur are situated on the posterior aspect of 
the upper end of the shaft, the great trochanter being placed 
externally and the small trochanter internally. Where the neck 
joins the shaft a distinct line is seen, the intertrochanteric line 
in front, and behind where it is more prominent it is called the 
intertrochanteric ridge (crista intertrochanterica) . Just above 
the middle of this ridge is the quadrate tubercle. The great 
trochanter overhangs the neck above, and in the depression thus 
formed is found the digital fossa for the tendon of obturator ex- 
ternus. On its external surface is an oblique line running from 
above downwards and forwards. The small trochanter is a 
rounded eminence confluent with the shaft below. 

The Shaft is cylindrical in shape and convex forwards, 
increasing in size gradually from above downwards. At its 
lower end it is flattened to support the condyles. The shaft is 
smooth except on its posterior surface, where a narrow longitu- 
dinal ridge is found the linea aspera. This has distinct inner 
and outer lips, which separate inf eriorly, each passing down to 
its own condyle and enclosing a smooth triangular space the 
popliteal surface. Where the inner lip meets the condyle is a 
small tubercle the adductor tubercle. 

The Lower Extremity of the femur is flattened and recurved 
posteriorly to form two condyles, between them being the deep 
intercondylic notch. In front they are united to form a smooth, 
flat surface for the patella. The inner condyle is longer and 
narrower than the outer one; but as the femur in its normal 



44 



HANDBOOK OF ANATOMY 

Head. .Neck 



Depression for 
Liganientum Teres - 



Ilio psoas ".. 
Small Trochanter 



Spiral Line 

Adductor Brevis 

Vastus Interims 
Adductor Longu 



y- I I 
j d.J Gluteal Ridge and 

*' ,' | j I Gluteus Maximus 



Internal Supracondylar 

Fudge and hxpansion from Tendon 

of Adductor Magnus 



Adductor Tubercle 
and Adductor Magnus 



Internal Tuberosity/ 




Digital Fossa and Obturator Externus, 
^Quadrate Tubercle 



Gluteus Medius 
-Great Trochanter 



-4 Medullary Foramen 



Summit of Linea Aspera 

Outer Lip of Linea Aspera 



Inner Lip of Linea Aspera _/_ J ; 



External Supracondylar Ridge 



_ J Popliteal Surface 



External Tuberosity 

External Condyle 



Internal Condylei Intercondylar Fossa 

FIG. 13. FEMUR. 



BONES OF LOWER LIMB 45 

position is placed obliquely i.e., the upper extremities being 
widely separated by the pelvis while the lower extremities are 
in apposition to one another, the inferior surfaces normally 
are in the same horizontal plane ; whereas if the femur is held 
vertically, the inner condyle projects downwards below the 
outer one. The inner surface of the inner condyle and the 
outer surface of the outer condyle are subcutaneous, and each 
possesses a pronounced tuberosity for the attachment of 
ligaments. 

The Inferior Surface of the femur is cartilage covered for 
articulation with the head of the tibia. It is more or less 
crescentic in form, the convexity being forwards. The anterior 
part is called the trochlea, and articulates with the patella. 
The inferior surfaces of the condyles are convex in both direc- 
tions. That of the outer one is wider than the inner, and 
rises to a higher, point on the anterior surface of the shaft. 
They each articulate with the tibia by means of a meniscus 
of cartilage, which separates the bones from one another. 

Ossification. There is one primary centre for the shaft before 
birth, secondary centres appearing for the head, trochanter and 
lower extremity. (This latter may appear just before birth.) 
The whole bone is fused together by the twenty-second year. 

The Patella is the largest sesamoid bone in the body, and 
is formed in the tendon of the quadriceps extensor in front 
of the knee-joint. It is triangular in shape, with the apex 
downwards. The anterior surface of the bone is slightly convex . 
The posterior surface is much more rounded, and has a ridge 
which divides it into two parts longitudinally, of which the 
inner one is the smaller. This ridge glides between the two 
condyles of the femur. 

Ossification. The patella does not begin to ossify till about 
the third year, and is complete at puberty. 

The Tibia is the inner bone of the leg. It is a long bone 
with a shaft and two extremities, and articulates above with 
the condyles of the femur and the upper end of the fibula ; 
below, with the lower end of the fibula and one tarsal bone, the 
astragalus. 

The Upper Extremity is much expanded, and forms two 



46 



HANDBOOK OF ANATOMY 



External Tuberosity of Tibia ., 

Biceps Femoris ' 
Head of FibuIa-J 



Peroneus Longus 



Extensor Proprius Hallucis 

Antero-external Border. 



Internal Tuberosity of Tibia 
Tubercle 

"^Gracilis 
NV 5artorius 

^ Semitendinosus 



External Surface and 

Tibialis Anticus 

- Anterior Border or Crest 



Postero-external Border .. 



Peroneus Brevis \ 



Internal Border 



Peroneus Tertius 



Triangular Subcutaneous. ___ 
Surface 



External Malleolus.-A--- 

Internal Malleolus 

FIG. 14. TIBIA AND FIBULA (ANTERIOR SURFACE*). 



BQNES OF LOWER LIMB 47 

tuberosities to support the condyles of the femur. The outer 
one somewhat overhangs the shaft. On the upper aspects 
of these are two smooth semicircular surfaces for the articular 
menisci, and between them in the centre a rough elevation, 
the intercondyloid spine. Where the outer tuberosity over^ 
hangs the shaft is a small articular facet for the head of the 
fibula. On the posterior surface of the inner tuberosity is a 
short horizontal groove for the semimembranosus muscle. In 
front of the lower part of the two tuberosities is a large 
tubercle, the upper half of which is smooth and covered 
by a bursa ; the lower, rough, for the attachment of the 
ligamentum patellae. 

The Shaft is triangular in shape, having an anterior, internal, 
and external borders, and internal, external, and posterior 
surfaces. The anterior border is sharp and subcutaneous, form- 
ing what is known as the shin. The internal surface is also 
subcutaneous, except in its upper fourth. On the posterior 
.surface is seen the oblique, or popliteal, line, which runs from 
the outer tuberosity to the internal border at T:he junction of 
the upper and middle thirds. The posterior surface is divided 
into two parts by a vertical line dropped from the middle of the 
oblique line. 

The Lower Extremity is expanded and becomes quadrilateral. 
The external surface has a large articular area for the lower 
end of the fibula, and the internal surface is continued down- 
wards into a triangular process, called the internal malleolus,. 
whose outer surface is confluent with the inferior surface of 
the shaft, and articulates with the astragalus. On the posterior 
surface just external to the malleolus there are two grooves for 
the passage of tendons. 

Ossification. At birth the shaft is almost completely ossified, 
and a centre has appeared in the upper extremity. Very early 
the centre appears for the lower extremity, and the whole bone 
is fused together by the twenty-fourth year. 

The Fibula is a long, slender bone on the outer side of the 
leg. It articulates above with the outer tuberosity of the tibia, 
and below with the lower end of the tibia and the outer surface 
of the astragalus. 



48 



HANDBOOK OF ANATOMY 



Semimembranosus 



Internal Tuberosity of Tibia - 



Tibial Spine 

' Popliteal Notch 



,-Styloid Process of Fibula 



Popliteal Surface and . 
Popliteus 



Soleus 
Oblique Line 



Tibialis Posticus 

Medullary Foramen 

Tnternal Border 

Flexor Longus Digitorum 



1 



~{ -- Soleus 

Posterior Surface 

I Postero external Bolder 

Flexor Longus Ka'.lucis 

Medullary Foramen 



H- 



1 Peroneus Brevis 

Postero-extennal Border 

Antero-external Border 



Tip of Internal Malleolus, 

Groove for Tibialis Posticus and 
Flexor Longus Digitorum 



Peroneal Groove 
Tip of External Malleolus 
Groove for Flexor 
T.-n-us Hallucis 



. 15. TIHIA AND FIBULA (POSTERIOR SURFACES), 






BONES OF LOWER LIMB 49 

The Upper Extremity is irregularly rounded, and has on its 
internal surface a facet for articulation with the tibia, and just 
.above this is a pointed process the styloid process. 

The Shaft is very irregular in shape and twisted on itself, but 
.a very narrow anterior surface can be distinguished between 
the interosseous and external borders. The external border 
splits below to form a triangular subcutaneous area on the 
outer malleolus, and behind this line is the external surface. 
The surface next the external surface is the posterior surface, 
which is divided by a sharp ridge. (This ridge may be mistaken 
for the interosseous ridge, but that can be determined by follow- 
ing up the line from the triangular surface on the malleolus. 
This line is the external border of the anterior surface.) 

The Lower Extremity is flattened and expanded to form the 
-external malleolus, on the internal surface of which is the facet 
for articulation with the outer surface .of the astragalus. Just 
behind this facet is the digital fossa for the insertion of a 
ligament. 

Ossification is similar to that of the tibia, except that the 
centre for the shaft is the only one that appears before birth. 

The Tarsus is composed of seven bones the astragalus, os 
'calcis, scaphoid, cuboid, and three cuneiforms. 

The Astragalus is the uppermost bone, and, articulating with 
the tibia and fibula, supports the weight of the body. It is 
of irregular cubical form, and on the upper, inner, and outer 
surfaces is one large confluent articular facet, fitting into the 
;space enclosed by the under surface of the tibia, and the two 
malleoli. This facet is saddle-shaped, and is broader in front 
than behind. Anteriorly is a somewhat constricted neck sup- 
porting the rounded head, which articulates with the scaphoid 
bone. On the inferior surface is a large concave facet for 
articulation with the os calcis. A deep groove divides this facet 
into two parts, the anterior part articulating with the susten- 
taculum tali, while the posterior part rests on the body of the 
os calcis. A strong interosseous ligament is inserted in this 
groove. Posteriorly the bone is divided by a groove, oblique 
from above downwards and inwards, into two tubercles. In 
the groove runs the tendon of tibialis posticus. 

4 



50 



HANDBOOK OF ANATOMY 



Tuber Calcis 



Os Calcis (Neck) 

Tubercle for Middle Fasciculus - 
of External Lateral Ligament 



Peroneal Spine or Ridge .. 

Extensor Brevis Digitorum . - - \ 

Cuboid 
Peroneus Brevis- 

Peroneus Tertius*- 
External Cuneiform-"^ 



s / 

Extensor Longus Digitorum " N - 




Astragalus 



Navicular (Scaphoid> 



Groove for Tibialis 

Anticus 
Internal Cuneiform 



Middle Cuneiform 



- Innermost Tendon of 

Extensor Brevis 

Digitorum 



Extensor Proprius- 
Hallucis 



Fro. 16. BONES OF FOOT (DOUSAL SURFACE), 






BONES OF FOOT 51 

The OS Calcis is the largest bone of the tarsus. It is roughly 
cubical, with a projection posteriorly, forming the heel. The 
upper surface has anteriorly two facets, divided by a groove 
to correspond with the facets on the under surface of the 
astragalus. On the outer side of the anterior facet is a rough 
surface for muscular origins. The anterior surface has a smooth, 
convex surface articulating with the cuboid bone. Posteriorly, 
the tuberosity, which is confluent with the body of the bone, 
1ms a surface divided into three parts. The upper part is 
smooth and covered by a bursa, the middle portion is roughened 
for the attachment of the tendo A-chillis, and the lower part 
is rough and confluent with the inferior surface. On the inner 
surface of the body is the sustentaculum tali, a stout projection 
of bone supporting the astragalus. On the outer surface is the 
peroneal spine, a small tubercle separating the tendons of 
peroneus longus and brevis. 

The plantar surface is slightly concave from before back- 
wards, and roughened for the attachment of muscles and 
ligaments. Posteriorly, there are two tubercles, of which the 
inner one is the larger. 

The Scaphoid is a flat, oval bone, compressed from before 
backwards, the long axis being horizontal. It articulates pos^ 
teriorly with the head of the astragalus, and anteriorly with the 
three cuneiform bones. The inner surface of the bone projects 
beyond the inner border of the foot, and forms a rounded 
tubercle easily felt in the living subject. 

The Cuneiform Bones are three in number internal, middle, 
and external. They articulate posteriorly with the scaphoid, 
and anteriorly with the first, second, and third metatarsals. 
They are wedge-shaped in form, with the points downwards, the 
first being the largest, and not so pointed inferiorly as the 
others. This arrangement helps to keep the concave plantar 
surface presented by the bones of the foot. 

The Cuboid Bone is roughly cubical, and lying on the outer 
side of the foot articulates posteriorly with the anterior surface 
of the os calcis and anteriorly with the fourth and fifth meta- 
tarsals. On its inner side it articulates with the external cunei- 
form bone. On the plantar surface is an oblique ridge running 



52 



HANDBOOK OF ANATOMY 



Tuber Calcis 



Sustentaculum Tali 

Tibialis Posticus 

Peroneus Longus 



Tibialis Anticus 



Abductor Hallucis and. 
Inner Head of Flexor 

Brevis Hallucis 
Outer Head of Flexor- 
Brevis Hallucis, Adduc- 
tor Obliquus Hallucis, 
and Adductor Trans- 
versus Hallucis 



Flexor Longus Hallucis ' 




Abductor Minimi Digiti 



Outer Head of Flexor 
Accessorius 



Tuberosity of 5th 
Metatarsal and 
Peroneus Brevis 



Adductor Obliquus 
Hallucis 



. .Abductor Minimi 
Digiti and Flexor 
Brevis Minimi 
Digiti 



Flexor Brevis Digitorum 



Flexor Longus Digitorum 

FIG. 17. BONES OF FOOT (PLANTAR SURFACE). 



BONES OF FOOT 53 

from without inwards and forwards, and just in front of this a 
groove for the tendon of peroneus longus. 

Ossification. The astragalus and the os calcis are partially 
ossified at birth. The other bones commence early in life, and 
the tarsus is completely ossified by the twentieth year. 

The Metatarsus resembles the metacarpus, and consists of five 
long bones articulating with the tarsus behind and supporting 
the phalanges in front. 

The first metatarsal is the shortest and stoutest and the second 
metatarsal the longest. The fifth metatarsal has a prominent 
tubercle projecting backwards from the outer side of the base, 
which can easily be felt in the living subject. The metatarsals 
articulate with one another by their bases. 

Ossification. Similar to that of the metacarpus. 

The Phalanges of the toes resemble those of the fingers in 
shape and number (fourteen in all). They are, however, much 
smaller proportionately^ and in the smaller toes the second and 
third phalanges are often compressed to mere nodules. 

Ossification. Similar to that of the fingers. 

Articulations of the Pelvis. 

Lumbo-SaCPal Joint. This takes place between the fifth 
lumbar vertebra and the sacrum, and is similar to the other 
intervertebral joints. It has, however, an accessory ligament, the 
lateral lumbo-sacral ligament, which is attached to the front of 
the transverse process of the fifth lumbar vertebra and the front 
of the sacrum close to the sacro-iliac joint. 

SaCPO-Iliac Joint between the articulating portion of the 
wing of the ilium and the similar auricular surface on the 
sacrum. The joint surfaces are very closely applied to one 
another, so that movement is limited, as great stability is required 
rather than free movement. The joints are just movable enough 
to prevent absolute rigidity, and their roughened surfaces prevent 
gliding to any extent. 

Ligaments. A capsular ligament surrounds the joint, which is 
strengthened by transverse fibres dorsally and ventrally. 

The synovial membrane is rudimentary. 

Accessmy Ligaments : The Ilio-Lumbar ligament extends from 



54 HANDBOOK OF ANATOMY 

the tip of the transverse process of the fifth lumbar vertebra to 
the iliac crest just behind its highest point. It is in reality a 
thickened portion of the lumbar fascia. 

The Great Sciatic Ligament is triangular in shape. It is 
attached to the posterior inferior spine of the ilium, the tuber- 
osity of the ischium, and to the posterior aspects of the lower 
part of the sacrum. It fills the gap between the innominate 
bone and sacrum, and, by completing the great and small sciatic 
notches, forms the great and small sacro-sciatic foramina. 

The Small Sciatic Ligament is also triangular ; it lies vent rally 
to the great sciatic ligament, and is attached by its base to the 
last two segments of the sacrum, and by its apex to the spine of 
the ischium. 

The Symphysis Pubis is an immovable joint between the two 
pubic bones. The articular surfaces are covered with cartilage 
as usual, and have, in addition, an interarticular disc of cartilage 
welding them firmly together. There are ligaments all round 
the joint, the most important being the subpubic ligament, which 
is in the arch of the pubis and separated from the triangular 
ligament of the perineum by a small interval. The subpubic 
ligament is attached to the interarticular ligament and the 
descending rami of the pubic bones. There is no synovial 
membrane. 

The Triangular Ligament of the perineum helps to complete 
the pelvic walls, and stretches across between the descending 
rami of the pubic bones. It occupies a horizontal position, and 
has superior aud inferior surfaces. Posteriorly it fuses with the 
deep fascia of the perineum. 

The Obturator Membrane fills the obturator foramen, leaving 
superiorly a small canal, through which vessels and nerves pass. 

There are no muscles acting on these joints in the ordinary 
way, the joints being for the sole purpose of preventing absolute 
rigidity, so that the pelvis will "give" to the pull of the muscles 
as required. 

The Hip- Joint takes place between the head of the femur and 
the acetabulum of the innominate bone. 

It is a true ball-and-socket joint, so has movement round three 
axjes : 



HIP-JOINT 



Transverse flexion and extension. 

Antero-posterior abduction and adduction. 

Vertical rotation in and out. 

Ligaments. The Transverse Ligament is composed of strong 
fibres, which bridge across the notch in the margin of the 
acetabulum, leaving a gap through which vessels and nerves can 
pass. 

The Cotyloid Ligament surrounds the margin of the aceta- 
bnlum and deepens the socket. Its free edge is somewhat 
constricted, and grasps the head of the femur. 



Pubo-femoral Band 




.interior Inferior Iliac Spine 



Ilio-femoral Band 
(Y Ligament 
of Bigelow; 



Anterior 



Obturator Membrane 



FIG. 18. HIP- JOINT. 

A capsule completely surrounds the joint. It is considerably 
thicker superiorly. This capsule differs from that of the 
shoulder- joint in not allowing the ball to be drawn from the 
socket to any considerable extent. The ligament is attached 
above to the margin of the acetabulum and below to the cotyloid 
and transverse ligaments. On the neck of the femur it is 
attached above to the root of the great trochanter, in front to 
the intertrochanteric line, below to the root of the small tro- 
chanter, and behind a little way above the intertrochanteric 
ridge. The fibres of the capsule are arranged in both the 
circular and longitudinal directions to give additional strength, 



56 HANDBOOK OF ANATOMY 

and definite bands of longitudinal fibres are strengthened as- 
follows : 

The Ilio- Femoral ligament (Y-shaped ligament of Bigelow) is a 
triangular ligament attached by its apex to the root of the 
anterior inferior spine and margin of the acetabuluin and by its 
base to the intertrochanteric line. At the base the sides are 
thicker than the centre, hence its name. 

The Pubo- Femoral ligament, attached to the acetabular end 
of the ramus of the pubis and the inferior aspect of the neck of 
the femur. 

The Ischio-Capsular ligament attached above to the ischium 
just in front of the small sciatic notch ; the lower end becomes 
merged in the capsule. 

The Ligamentum teres is a flattened band of tissue attached by 
one end to the fossa on the summit of the head of the femur and 
by the other end to the sides of the notch in the margin of the 
acetabulum. A pad of fat occupies the bottom of the aceta- 
bulum. 

The synovial membrane completely lines the joint and the 
ligaments, and hangs in loose folds between the articular margin 
and the attachment of the capsule on the neck of the femur. 

MUSCLES ACTING ON THE JOINT. 



Action. 
Flexion 


Muscle. 


Origin. 


Insertion. 

Outer side of tendon of 
psoas ; anterior sur- 
face of small tro- 
chanter, and shaft of 
femur below 


Nerve-supply. 

Anterior 
crural 


Iliacus 


From a wide origin 
round the margin of 
the iliac fossa 




Psoas 


From theintervertebral 
discs, and adjacent 
margins, side of 
bodies, and transverse 
processes of lumbar 
vertebrae 


Apex of small trochantei 
of femur 


Nerve from 
the lumbar- 
plexus 




Sartorius 


From the anterior supe- 
rior spine of the ilium, 
and half the notch 
below it 


Inner surface of shaft of 
tibia just below the 
tuberosity 


Anterior 
crural 




Rectus 

femoris 


See Quadriceps Extensor 


(Knee-joint) 





HIP-JOINT 

MUSCLES ACTING ON THE JOINT Continued. 



57 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Flexion 

(c&ntd. ) 


Pectinens 


From'the triangular sur- j Into the upper half 
face of the pubic bone 1 (about 2 inches) of 


Anterior 
crural 






behind the crest 


the line from the 










small trochanter to 










the linea aspera 






Gracilis 


From the edge of the 


Into the inner side of 


Obturator 






symphysis pubis and 


the tibia, just below 








a small portion of the 


the tuberosity behind 








border of the adjoin- 


sartorius 








ing pubic arch 






Exten- 


Gluteus 


From the area on the 


The gluteal ridge (from 


Inferior 


sion 


maximus 


posterior part of the 
dorsum ilii between 


the root of the great 
trochanter) and the 


gluteal 






the crest and the 


deep fascia covering 








superior curved line ; 


the thigh 








the tendon of erector 










spinse ; posterior sur- 










face of sacrum, and 








great sciatic ligament 






Glutens 


From the area on the 


Into the oblique line on 


Superior 


medius 


dorsum ilii between 


the outer surface of 


gluteal 






the superior curved 


the great trochanter 








line and crest above 










and the middle curved 










line below ; and deep 










fascia 








Gluteus From the area on the 


The anterior surface of 


Superior 




minimus dorsum ilii between 


the great trochanter 


gluteal 






the middle and in- 










ferior curved lines 








Biceps 


From the lower and 


The head of the fibula, 


Great 




femoris 


inner half of the 


and by a slip to the 


sciatic 






ischial tuberosity ; 


outer tuberosity of 








and short head, from 


the tibia 








the whole length of 










the outer lip of the 










linea aspera, and the 










upper two-thirds of 








| the outer supra-con - 










dyloid ridge and inter- 










muscular septum 








Semi- 


From the lower inner 


The inner side of shaft 


Great 




tendinosus 


facet on the ischial 


of tibia, below the 


sciatic 






tuberosity with the 


gracilis and behind 








long head of biceps 


sartorius 






Semi- 


From the upper outer 


The horizontal groove 


Great 




mem- 


facet on the ischial on the posterior sur- 


sciatic 




branosus 


tuberosity 


face of the inner 










tuberosity of the tibia 



HANDBOOK OF ANATOMY 

MUSCLES ACTING ON THE JOINT Continued. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Exten- 
sion 
(contd.) 


Adductor 
maguus 


From a curved origin on 
the inferior surface of 
the ischial tuberosity, 
and the lower border 
of the ischial ram us 
and that of the pubis 


The space below the 
insertion of quadratus 
femoris, the whole of 
the linea aspera, the 
inner supracondyloid 
ridge and intermuscu- 
lar septum of the 
femur, and the adduc- 
tor tubercle 


Obturator 


Abduc- 
tion 


Tensor 
fascia 
femoris 


From the anterior supe- 
rior spine of the ilium 
and the crest just 
behind 


The ilio-tibial band at 
the level of the great 
trochanter 


Superior 
gluteal 




Gluteus 
medius 
(anterior 
fibres) 


See Extension 








Gluteus 


See Extension 








minimus 
(anterior 
fibres) 








Adduc- 
tion 


Adductor 
longus 


By a rounded tendon 
from the anterior sur- 
face of the body of 
the pubis between the 
crest and the sym- 
physis 


The middle half of the 
inner lip of the linea 
aspera in front of 
adductor magnus 


Obturator 




Adductor 
brevis 


From the front of the 
body and descending 
ram us of the pubis 


Into the lower two- 
thirds of the line lead- 
ing from the small 
trochanter to the linea 
aspera behind pec- 
tineus 


Obturator 




Adductor 


See Extension 








magnus 










Gracilis 


See Flexion 








Pectineus 


See Flexion 






Rotation 
in 


Gluteus 
medius 
(anterior 
fibres) 


See Abduction 








Gluteus 
minimus 
(anterior 
fibres) 


See Abduction 







KNEE-JOINT 



59 



MUSCLES ACTING ON THE JOINT Continued. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Rotation 


Tensor 


See Abduction 






in 


fasciae 








(contil] 


femoris 








Rotation 


Pyriformis 


From the middle part 


A facet on the inner 


Nerve from 


out 




of the anterior surface ! aspect of the upper 


the sacral 






of the sacrum ; and 


border of the great 


plexus 






the upper margin of 


trochanter 






the great sciatic notch 








Obturator 


From the inner surface 


Just behind pyriformis 


Nerve from 




internus 


of the bone surround- 




the sacral 


| and 


ing the obturator for- 




plexus 




gemelli 


amen and from the 










membrane ; the ge- 










raelli, one from the 










ischial spine, the 










other from the tuber- 










osity (either side of 


. !' 








the small sciatic notch) 






Obturator 


From the lower half of 


The digital fossa at the ! Obturator 




externus 


the obturator mem- , inner aspect of the 






brane and the bone 


upper border of the 








surrounding 


great trochanter 




Qnadratus 


From the outer margin 


The quadrate tubercle 


Nerve from 




femoris 


of the ischial tuber- 


and line beyond 


the sacral 






osity 




plexus 




This act 


ion is helped by a great 


many of the other muse 


les. 




Circumd 


uction a combination 


of the other movements. 





The Knee-Joint is formed between the condyles of the femur 
and the superior surface of the head of the tibia. The posterior 
surface of the patella also enters into the joint. 

A hinge-joint capable of movement round one axis only : 

Transverse flexion and extension. 

A capsule surrounds the joint. It is, however, incomplete in 
wfront where the tendon of the quadriceps extensor takes its 
place. It has, as usual, distinct bands of fibres forming 
strengthening fibres ; but they are not sufficient, so that expan- 
sions from the tendons of adjacent muscles are also found. 

The Anterior Ligament (ligamentum patellae) is a strong flat 
band, the tendon of the quadriceps extensor, attached to the 
.apex and margins of the patella, and continued on to be inserted 



60 



HANDBOOK OF ANATOMY 



Gluteus Medius .... 



Gluteus Maximus . 



Biceps 
Semitendinosus 

Semimembranosus ._ 
Crureus 



Gracilis 

Internal Popliteal Nerve 
Sartorius 



Gastrocnemius 



Soleusj ". Jl"_" 

Flexor Longus 
Digitorum 

Peroneus Longus 

TendoAchillis- 

Tibialis Posticus 

Plantaris 




j|- Hio-hypogastric Nerve 

. Lateral Cutaneous of 

Tzth Thoracic Nerve 

"Posterior Divisions of 

first three Lumbar 

Nerves 



-..Posterior Divisions of 
Sacral Nerves 

....Post. Div. ofCocc. N. 
...Perforating Cutan. N. 
_Gluteal Branches of 
Small Sciatic Nerve 
"Post. Branch of Ext. 
Cutaneous Nerve 



Small Sciatic Nerve 

(Outline) 

Femoral Branches of 
Small Sciatic Nerve 



Ext. Cutaneous N. 
(Anterior Branch) 



LiM Small Sciatic Nerve 



Posterior Branch of Int. 

Cutaneous Nerve 
Lateral Cutaneous of 
External Popliteal 
Nerve 



Ramus Commun. Fib. 
Ramus Comm,un. Tib. 



... Ext. Saphenous Nerve 



It::-* Branches of Internal 
Saphenous Nerve 



FIG. ,19. MUSCLES AND CUTANEOUS NERVES OF LEG (POSTERIOR VIEW). 



MUSCLES OF LOWER LI Ml? 



61 



Obliquus Externus Abdominis 



Gluteus Medius .. 



Tensor Fasciae Femoris 
Psoas Magnus 



Adductor Longus - 
Gracilis - 

Rectus Femoris - 
Ilio-tibial Band - 

Vastus Externus 
Vastus Internus 



Ext. Abdominal Ring 



Ligamentum Patella- 



Vjastrocnemms- 



Peroneus Longus 
Soleus 

Kxt. Longus Digitorum 

Kxt. Propnus Hallucis 

Tibialis Auticus 

Peroneus Tertiu. 

Anterior Annular 

Ligament 




Ext. Cutaneous Nerve 

... Crural Branch of Genito- 

cniral Nerve 
... Inguinal Nerve 

Saphenous Opening 
-.Mid. Cutaneous Nerve 



Int. Saphenous Vein 

Int. Cutaneous Nerve 
(Outline) 



Ant. Branch of Internal 
Cutaneous Nerve 



Patellar Plexus of Nerves 
Patellar Branch of Internal 

Saphenous Nerve 
Int. Saphenous Nerve 
Int. Saphenous Vein 
Post. Branch of I nternal 
Cutaneous Nerve 



Cutaneous Part of Musculo- 

cutaneous Nerve 
-' Calcaneo-plantar Nerve 

-. Int. Saphenous Nerve 
(Terminal Part) 



FIG. 20. MUSCLES AND CUTANEOUS NERVES OF LEG (ANTERIOR VIEW). 



62 



HANDBOOK OF ANATOMY 



into the anterior tubercle of the tibia. Expansions of the vast! 
tendons, called lateral patellar ligaments, augment this. 

The Posterior ligament is attached superiorly to the popliteal 
surface of the femur just above the intercondyloid notch and the 
two condyles; below to the posterior border of the head of the 
tibia; on the fibular side, is an opening for the tendon of 



Anterior Crucial 
Ligament 



External Semilunar 

Fibro-cartilage 
Synovial Membrane 

Long External Lateral. 

Ligament 
Posterior Superior - 
Tibio-fibular 
Ligament 




Internal Semilunar 
Fibro-cartilage 



;ffl r'^^^^M - s y novial M <^ rane 

^^.^>'S3K.Internal Lateral 



Ligament 
" Post. Accessory Bundle 

Posterior Crucial 
Ligament 



FIG. 21. KNEE-JOINT (POSTERIOR VIEW). 



popliteus. The tendon of semimembranosus forms an ex- 
pansion to strengthen the ligament, called the oblique popliteal 
ligament. 

The Internal Lateral ligament is a strong, flat band, rather 
wider in the middle. It is attached above to the inner surface of 
the internal condyle just below the adductor tubercle, and below 
to the inner surface of the internal tuberosity of the tibia, 



KNEE-JOINT 6a 

reaching round to the part above the groove for semimem- 
branosus. 

The External Lateral ligament is a rounded ligament attached 
above to a tubercle on the outer surface of the external condyle 
and below to the head of the fibula in front of the styloid pro- 
cess ; at its attachment it splits the tendon of biceps. This 
ligament is inside the capsule and not part of it. 

The Inir a- Articular Ligaments. The ligaments inside the 
knee-jointure more important than the intra- articular ligaments 
of any other joint. 

The Crucial ligaments are two rounded tendinous bands at- 
tached to the head of the tibia and the non-articular surfaces of 
the condyles of the femur ; they are called anterior and posterior, 
according to their tibial attachment. The Anterior Crucial liga- 
ment is attached to the head of the tibia just in front of the 
spine, and passes upwards and backwards, to be attached to the 
posterior part of the inner surface of the external condyle. 
This ligament is tense during extension. The Posterior Crucial 
ligament is attached to the head of the tibia behind the spine, 
and passes upwards and forwards, to be attached to the anterior 
part of the outer surface of the internal condyle. This ligament 
is tense during flexion. 

The Semilunar Cartilages are placed between the articulating 
surfaces of the tibia and femur ; they each have a thick convex 
outer border attached to the surface of the tibia, and a concave 
inner border ending in horns, anterior and posterior. The 
internal one forms nearly a semicircle. The anterior horn is 
attached just in front of the anterior crucial ligament, and the 
posterior horn just in front of the posterior crucial ligament 
between it and the spine. The external one is nearly circular, 
its two horns being attached one each side of the spine. 

The transverse ligament is a rounded band stretched between 
the anterior margins of the two semilunar cartilages. 

The synovial membrane is very large and complicated. It 
completely invests the capsule, all the interarticular liga- 
ments, and a pad of fat which is found beneath the patella, 
where it forms a fold attached to the patella and the anterior 
part of the intercondyloid notch. This is called the plica 






64 HANDBOOK OF ANATOMY 

synovialis patellaris. In addition it forms at the patellar end 
wing-like expansions the plica alares - which are usually loaded 
with fat. 

MUSCLES ACTING ON THE JOINT. 



Action. 



Flexion 



Exten- 
sion 



Muscle. 

Hamstrin 
Biceps 

Semi- 
membran- 



Semiten- 
dinosus 

Sartorius 
Gracilis 

Gastroc- 
nemius 



Plaritaris 



Popliteus 



Quadr 

Rectus 
femoris 



Vastus 
externus 



Origin. 



gs, consisting of 



See Hip-Joint 



By two heads (1) On 
the upper part of the 
external condyle and 
supracoridyloid ridge ; 
(2) from the space 
between the internal 
condyle and the ad- 
ductor tubercle 

From the lower third of 
the outer supracondy- 
loid ridge 

By a tendon from the 
outer surface of the 
external condyle 



oeps extensor, consisting 

The straight head from 
the anterior inferior 
spine of the ilium and 
the reflected head 
from a groove just 
above the acetabulum 

From the anterior sur- 
face of the shaft of 
the femur in front of 
the great trochanter 
round to the outer lip 
of the linea aspera and 
its upper half ; deep 
fascia 



Insertion. 



Nerve-supply. 



The tendo Achillis in- 
serted in the middle 
part of the posterior 
surface of the os calcis 



The tendo Achillis, or a 
separate insertion on 
its inner side 

The triangular surface 
on the upper part of 
the posterior surface 
of the tibia above the 
oblique line 

of four parts 

The upper border of 
the patella and the 
ligamentum patella? 



The upper and outer 
border of the patella 
and the ligamentum 
patellae 



Tibial 



Tibial 



Tibial 



Anterior 
crural 



Anterior 
crural 



TIB JO- FIBULAE JOINTS 



65 



MUSCLES ACTING ON THE JOIST Continued. 



Action. 


Muscle, 


( >rigin. 


Insertion. 


Nerve -supply. 


Exten- 


Vastus 


From the lower two- 


The upper and inner Anterior 


sion 


internus 


thirds of the inter- 


border of the patella crural 


| 


trochantoric line, the 


and the ligamentum 




inner lip of the linea 


patellae 






aspera, and upper 










two-thirds of the line 






! 


from the linea aspera 










to the inner condyle ; 










deep fascia 








Crureus 


From the anterior and 


The deep surface of the 


Anterior ' 




(vastus 


outer surfaces of the 


tendons of rectus 


crural 




inter- 


upper tw T o-thirds of 


femorisand the vasti, 






medius) 


the shaft of the 


and the ligamentum 








femur ; the lower half 


patelLe 


i 






of the outer lip of the 










linea aspera and the 










line leading to the 










outer condyle ; deep 










fascia 










The Tibio-Fibular Joints are two in number, between the 
opposing surfaces of the extremities of the tibia and fibula. The 
fibula forms a lateral support for the ankle-joint, and is not 
required to have any independent movement, so these joints 
simply provide a certain amount of elasticity, and are slightly 
.gliding. 

The Superior Tibio-Fibular Joint is formed between the small 
oval facet on the inner surface on the head of the fibula, and 
the facet on the posterior part of the external tuberosity of the 
tibia. It is surrounded by a capsule and several strengthening 
ligaments, more or less defined. 

The synovial membrane is sometimes continuous with that of 
the knee-joint. 

The Inferior Tibio-Fibular Joint is formed between the op- 
posing surfaces of the lower ends of the tibia and fibula; this is 
not always a separate joint, but may be only a series of liga- 
ments accessory to the ankle-joint. The ligaments are particu- 
larly strong. 

The Anterior Inferior Tibio-Fibular ligament is a strong band 



66 HANDBOOK OF ANATOMY 

of fibres attached to the front of the lower end of the tibia and 
the outer malleolus. 

The Posterior Inferior Tibio-Fibular ligament is also a strong" 
band of fibres attached similarly on the posterior aspect of the 
bones. 

The Transverse Inferior Tibio-Fibular ligament is attached to 
the posterior inferior border of the tibia, and the pit or fossa on 
the posterior part of the inner surface of the external malleolus. 

The Interosseous ligament connects the opposing surfaces; it 
is continuous above with the interosseous membrane, and 
attached in front and behind to the ligaments. 

The synovial membrane lining the joint cavity is continuous 
with that of the ankle-joint. 

The Interosseous membrane attached to the interosseous borders 
may be considered an accessory ligament to these joints. It 
joins the inferior tibio-fibular joint below and may join the 
superior tibio-fibular joint above, but there is always an opening 
in its upper part for the anterior tibial vessels. Its fibres are 
mainly directed downwards and outwards. 

The Ankle- Joint, between the upper, inner, and outer surfaces 
of the astragalus and the lower ends of the tibia and fibula. 

It is a hinge joint, capable of movement round one axis only : 

Transverse flexion arid extension. 

Owing to the shape of the articular surface of the astragalus, 
which is wider in front than behind, a slight side to side rocking 
movement can be produced during extension, as in this position 
the narrower portion of the astragalus is in the tibio-fibular 
socket. During flexion the wider part of the astragalus is forced 
into the socket, and the joint is, so to speak, " locked," and 
inversion and eversion of the foot can only be performed by out- 
side force. This movement takes place in the joint between the 
cuboid and os calcis, and between the astragalus and scaphoid,, 
not at all in the ankle-joint itself. 

A capsule completely surrounds the joint, and has various 
strengthened parts. 

The Anterior ligament is a thin ligament attached above to the 
anterior edge of the tibia, and below to the upper border of the* 
head of the astragalus. A pad of fat fills the hollow between. 



ANKLE-JOINT 



67 



The Posterior ligament is attached to the edges of the tibia 
and astragalus, and receives some fibres from the external 
malleolus. The transverse ligament of the inferior tibio-fibular 
joint strengthens this aspect of the ankle-joint. The - liga- 
ment on the external aspect of the joint is divided into three 
parts : 

1. Anterior Part of the ligament from the anterior border of 
the external malleolus to the astragalus in front of the articular 
surface. 



.Anterior Inferior Tibio-fibular 
Ligament 



Anterior Band of External 
Lateral Ligament 




Posterior Inferior 
Tibio-fibular Lig. 

Posterior Band of... 
Ext. Lat. Lig. 



Middle Ban 
iixt. Lat. Lig. 



Peroneus Longus [ 

Peroneus Brevis 

FIG. 22. ANKLE-JOINT. 



2. Middle Part of the ligament from the lower border of the 
external malleolus to the external surface of the os calcis just 
above the peroneal spine ; this is a strong rounded cord. 

:>. Posterior Part of the ligament from the fossa on the inner 
surface of the external malleolus to the external tubercle on 
the posterior surface of the astragalus ; this is the strongest of 
the three parts. 

The Deltoid ligament is the one on the inner aspect of the 
joint ; it is triangular in shape and attached by its apex to the 



68 HANDBOOK OF ANATOMY 

lower part of the internal malleolus, and by its base to the inner 
surfaces of the scaphoid, astragalus, and os calcis, in one con- 
tinuous line. 

The synovia! membrane lines the joint and is continued up into 
the inferior tibio-fibular joint. Pads of fat are found in front 
and behind the joint, and in the socket where the three bones 
meet. 

The Intertarsal Joints are all gliding joints. They are sur- 
rounded by capsules which are divided into definite bands of 
fibres, as in the intercarpal joints. There are, however, three 
ligaments of special importance, as they are mainly responsible 
for supporting the longitudinal arch of the foot. 

The Inferior Calcaneo-Navicular or Spring ligament is an 
extremely strong band of fibro-cartilage. It is attached by one 
end to the sustentaculum tali of the os calcis, and by the other 
to the plantar surface of the scaphoid. Some of its fibres radiate 
upwards to join the deltoid ligament. 

The Inferior Calcaneo-Cuboid ligaments are two in number ; 
the superficial or long plantar ligament is attached by one end to 
the plantar surface of the os calcis in front of the tuberosities, 
and by the other to the ridge of the cuboid and passing over 
the groove to the bases of the third, fourth and fifth meta- 
tarsals. 

The deep or short plantar ligament is attached to the front of 
the plantar surface of the os calcis, and to the plantar surface of 
the cuboid just behind the ridge ; this is a short band of great 
strength. 

The tarso-metatarsal joints, intermetatarsal joints, metatarso- 
phalangeal joints, and interphalangeal joints all resemble the 
corresponding joints in the hand; but the movement is very 
limited, as the foot is for the purpose of supporting the weight 
of the body, and strength rather than flexibility has to be con- 
sidered. The toes can be spread to a certain extent, constituting 
abduction and adduction at the metatarso-phalangeal joints. 
This movement takes place about a line drawn through the 
second toe, not the middle one. Inversion the movement of 
raising the inner border of the foot and eversion raising the 
outer border of the foot has already been described. This can 



ARCHES OF FOOT 



69 



be done by outside force when the ankle is flexed, or voluntarily 
when the foot is on the ground. 

The Arches of the Foot. The foot having to support the 
whole weight of the body, that weight is distributed among 
its component parts by the arrangement of two arches at 
right angles to one another longitudinal and transverse. 



External Popliteal Nerve 

Tendon of Biceps _ 



Long External Lateral 
Ligament 




Peroneus Longus 
Peroneus Brevis 



TendoAcbillis.... 



Extensor Proprius Hallucis 

Extensor Longus Digitorurn 

Peroneus Tertius 

- Upper Division of Ant. Annular Ligament 
f Lower Division of Ant. Annular Lig. 
, Extensor Brevis Digitorum 
Tendon of Peroneus> Tertius 



FIG. 23. MUSCLES OF LEG. 



The Longitudinal Arch consists of a solid stable pier pos- 
teriorly the os calcis ; and an elastic resilient pier anteriorly, 
which is much broadened out and consists of several parts, so 
that stability is not sacrificed to resilience. The summit, or roof, 



70 



HANDBOOK OF ANATOMY 



of the arch is the astragalus. The bones of the foot are really 
arranged in two longitudinal columns. The inner one consists 
of the os calcis, scaphoid, three cuneiforms, and first, second, 
and third metatarsals; the outer one consists of the os calcis, 
cuboid, and fourth and fifth metatarsals. In this way the 
weight is evenly distributed to the front of the foot, which is 
necessary in the upright position, as the line of gravity falls 
in front of the knee-joint. The arch is kept in shape by the 
plantar ligaments, plantar fascia, and tendon of tibalis posticus 
which act as ties. 

The Transverse Arch is most marked at the tarso-rnetatarsal 
joints. The outer border of the foot is lower than the inner, so 
that when the two feet are placed side by side the transverse 
arch is complete. 

MUSCLES ACTING ON THE ANKLE-JOINT. 



Action. 


Muscle. 


Origin. 


Insertion. Nevve-supply. 


Flexion 


Tibialis 


From the external 


The anterior part of the Anterior 




anticus 


tuberosity and upper inner surface of the i tibial 
two-thirds of the outer first cuneiform and 






surface of the shaft of 


bane of the first meta- 






the tibia : the inter- 


tarsal 








osseous membrane and 










deep fascia 








Extensor 


From the outer tuber- 


The muscle divides into 


Anterior 




communis 


osity of the tibia and 


four tendons, and is 


tibial 




digitorum 


the upper two thirds 


inserted into the four 








of the anterior surface 


outer toes in the same 








of the shaft of the 


manner as the exten- 








fibula and deep fascia 


sors of the fingers 






Extensor 


From the anterior sur- 


The base of the terminal 


Anterior 




proprius 
hallucis 


face of the shaft of 
the fibula in its middle 


phalanx of the great 
toe (hallux) 


tibial 






three fifths ; internal 










to that of extensor 










communis digitorum 










and the interosseous 










membrane 








Peroneus 


Is really part of exten- 


The dorsal surface of Anterior 




tertius 


sor commuuis digit- the base of the fifth I tibial 






orum, and arises from metatarsal 








the lower part of the 








anterior surface of the 










fibulaand interosseous 










membrane 







MUSCLES OF ANKLE-JOINT 
MUSCLES ACTING OX THE ANKLE-.lOINT-CW/////' f v/. 



71 



Action, 


Muscle. 


Origin. 


Insertion. Nerve-supply. 


Exten- 
sion 


Gastrou- f 
nemius 


These constitute the gro 
and extend the ankle 


up called calf muscles, 
by raising the heel when ' 




Plantaris I 
Soleus V 


the foot is on the gro 
movement from true 


and a slightly different 
extension of the ankle . 




Gastroc- 


See Knee- Joint 






nemius 




- 




Plantaris 


See Knee-Joint 






Soleus 


(1) From the posterior 


Tendo Achillis 


Tibial 




surface of the head 






. 


i and upper two-thirds 








1 of the shaft of the 










fibula ; (2) from a 










fibrous arch between 










the tibia and fibula ; 










(3) from the oblique 










line and middle third 










of the inner border of 










the tibia 








Tibialis 


From the upper three- 


The plantar surfaces of 


Posterior 




postieus 


fourths of the shaft of 


all the bones of the i tibial 






the fibula between the i foot except the first 






oblique line and the metatarsal. As the 






interosseous border ; | tendon passes round 






the external tuber- the internal malleolus 








osity of the tibia and 


a slip is inserted into 








the inner half of the 


the sustentaculum tali 








upper two-thirds of 










the shaft below the 










oblique line ; the in- 










terosseous membrane 










and deep fascia 








Flexor 


From the middle half 


The muscle divides into 


Posterior 




longus 


of the posterior sur- 


four tendons, which 


tibial 




digitorum 


face of the shaft of 


are inserted into the 








the tibia internal to 


bases of the terminal 








that of tibialis pos- 


phalanges of the four 








tieus and deep fascia 


outer toes (cf. flexor 










profundus digitorum) 






Flexor 


From the lower two- 


The base of the terminal 


Posterior 




longus 
hallucis 


thirds of the posterior 
surface of the shaft of 


phalanx of the great 
toe 


tibial 






the fibula and the 










deep fascia 






Inver- 


Tibialis 


See Flexion 






sion and 


anticus 








Adduc- 










tion 


Tibialis 


See Extension 








postieus 






s 



72 



HANDBOOK OF ANATOMY 



MUSCLES ACTING ON THE ANKLE-JOINT 



Action. 


Muscle. 


( )rigin. Insertion. 


Nerve-supply. 


E version 


Peroncus 


From the head and 


The tendon passes 


Musculo- 


and 
Abduc- 


longus 


upper two-thirds of 
the outer "surface of 


through the groove in 
the cuboid, and is in- 


cutaneous 


tion 




the shaft of the fibula 1 serted on the outer 










surface of the first 










cuneiform and the 










base of the first meta- 










tarsal 






Peroneus 


From the lower two- 


The tubercle and outer 


Musculo- i 




brevis 


thirds of the outer surface of the base of 


cutaneous 






surface of the shaft of the fifth metatarsal 








the fibula 





MUSCLES ACTING ON THE METATARSO-PHALANGEAL JOINTS, 







I 


Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Flexion 


Flexor 


See Ankle-Joint 








longus 










digitorum 










Acces- 
sorius 


The outer head from The upper aspect of the 
the outer border of tendons of flexor 


External 
plantar 






the plantar surface of ! longus digitorum for 
the os calcis and the \ second, third, and 








long plantar liga- fourth toes 








ment ; the inner head 








from the inner surface 








of the os calcis and 








long plantar ligament 








Lumbri- 


The first from the tibial j The dorsal expansions First 


I 


cales 


side of the innermost i of the extensor ten- lumbricales 






tendon of the- flexor dons, etc., similar to from inter- 






longus digitorum ; the i the lumbricales in the nal plantar ; 






others from the adja- hand 


the others 






cent sides of the three j 


from exter- 






outer tendons 




nal plantar 




Flexor 


See Ankle-Joint 








longus 










hallucis 








Flexor 


From the inner part of i The tendon divides to Internal 




brevis 
hallucis 


the plantar surface of allow that of flexor ! plantar 
the cuboid and the longus hallucis to 






tendon of tibialis pos- 


pass, and is inserted 






ticus 


into the sides of the 








base of the first ; 






phalanx of the great ., 




toe 




i 



MUSCLES OF FOOT 



73 



MUSCLES ACTING ON THE METATARSO-PHALANGEAL 
JOINTS Continued. 



Action. 


Muscle. 


Origin. 


Insertion . 


Nerve-supply. 


Flexion 

(contd. ) 


Flexor 
brevis 
digitorum 

Flexor 
brevis 
minimi 
digiti 


From the greater 
tubercle on the plantar 
surface of the os calcis ; 
from the plantar fascia 
and the deep fascia 

! From the base of the 
fifth metatarsal bone 


The second phalanges 
of the four outer toes 
(cf. insertion of flexor 
sublimis digitorum in 
the hand) 

The outer side of the 
base of the first 
phalanx of the little 
toe 


Internal 
plantar 

External 
plantar 




Interossei 


See Abduction and Ad- 
duction 






Exten- 
sion 


Extensor 
longus 
digitorum 


See Ankle-Joint 








Extensor 
brevis 
digitorum 


From the upper surface 
of the os calcis in front 
of the articulation 


The innermost tendon 
is inserted into the 
base of the first 
phalanx of the great 
toe, the others into 
the dorsal expansions 
of the next three toes 


Anterior 
tibial 




Extensor 
proprius 
hallucis 


See Ankle-Joint 






Adducti 


on : to the 


middle line of the second 


toe 






Adductor 
obliquus 
hallucis 


From the plantar sur- 
face of the bases of 
the second, third, and 
fourth metatarsal 
bones 


The outer side of the 
base of the first 
phalanx of the great 
toe 


External 
plantar 




Adductor 
trans - 
versus 
hallucis 


From the capsules of 
the outer four meta- 
tarso - phalangeal 
joints and the trans- 
verse metatarsal liga- 
ment 


The outer side of the 
base of the first 
phalanx of the great 
toe 


External 
plantar 




Plantar 
interossei 


From the tibial sides of 
the third, fourth, and 
fifth metatarsal bones 
respectively 


With the dorsal muscles 
on to the tibial sides 
of third, fourth, and 
fifth toes 


External 
plantar 


Abducti 


n : from t 


he middle line of the seco 


id toe 






Abductor 
hallucis 


From the inner side of 
the greater tuberosity 
on the plantar surface 
of the os calcis and 
the plantar ligament 


The inner side of the 
base of the first 
phalanx of the great 
toe 


Internal 
plantar 



74 



HANDBOOK OF ANATOMY 



MUSCLES ACTING ON THE METATARSO-PHALANGEAL 
JOINTS Continued. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Abduc- 


Dorsal 


By two heads from the 


The first and second 


External 


tion 


interossei 


adjacent sides of the 


muscles are inserted 


plantar 


(contd. ) 




metatarsal bones 


on the tibial and fibu- 










lar side of the second 










toe respectively ; the 










two outer muscles are 










inserted on the fibular 










side of the third and 










fourth toes into the 










dorsal expansions 






Abductor 


From both tubercles on 


The outer side of the 


External 




minimi 


the plantar surface of base of the first 


plantar 




digiti 


the os ealcis, the ; phalanx of the little 








plantar fascia, and 


toe 








deep fascia 







MUSCLES ACTING ON THE INTERPHALANGEAL JOINTS. 



Action. 


Muscle. 


Origin. 


Flexion 
Extension 


Flexor brevis digitorum 
Flexor longus digitorum 
Flexor longus hallucis 
Extensor longus digitorum 
Extensor brevis digitorum 
Interossei 
Lumbricales 
Extensor proprius hallucis 


See Metatarso-Phalangeal Joint 
See Ankle-Joint 
See 
See 
See Metatarso-Phalangeal Joint 
See 
See 
See Ankle-Joint 



The short muscles of the toes in the sole of the foot are 
arranged in four layers beneath the plantar fascia. Starting 
at the outermost layer, they are 

First layer : Abductor hallucis, flexor brevis digitorum, ab- 
ductor minimi digiti. 

Second layer : Lumbricales and accessories, and the tendons 
of the long flexor muscles. 

Third layer : Flexor brevis hallucis, adductores hallucis, 
flexor brevis minimi digiti. 

Fourth layer : Interossei (plantar and dorsal) and tendons of 
peroneus longus and tibialis posticus. 



MUSCLES OF FOOT 



75 



.External Plantar Artery 



Peroneus Brevis 



Posterior Perforating 

Artery 
First Digital Artery 

Plantar Arch 
Second Digital A., 
Third Digital A. 
Fourth Digital A. 



Anterior Perforating. 
Artery 




/ Internal Calcaneal Artery 
^Posterior Tibial Artery 

^-Internal Plantar Artery 



.Tibialis Posticus 



--.Flex. Longus Digitorum 
- - Flex. Longus Hallucis 
-> -Flexor Accessorius 



Tendon of Abd. Hallucis 

Plantar Branch of 
--Dorsalis Pedis Artery 
Communicating Branch 



- Arteria Magna Hallucis 



FIG. 24. SHORT MUSCLES AND ARTERIES OF FOOT. 



76 HANDBOOK OF ANATOMY 

The Deep Fascia of the lower limb is continuous with that 
of the trunk, and that of the thigh is attached to the crest of 
the ilium, the pubic arch and symphysis, the great sciatic 
ligament, and Poupart's ligament; below it is attached to the 
patella, the tuberosities of the tibia, and the head of the fibula. 

On the* front of the thigh it is very thick, especially over 
the region of Scarpa's triangle, where there is an opening 
for the internal saphenous vein. On the outer surface of the 
thigh there is a strong band in the fascia, the ilio-tibial band, 
attached above to the iliac crest, and below to the outer tuber- 
osity of the tibia. At the knee it forms the lateral ligaments 
of the patella attached to the patella and the tuberosities of 
the tibia. Just above the knee the deep fascia sends in ex- 
pansions, intermuscular septa, which are attached to the supra- 
condyloid ridges. On the back of the thigh the fascia is 
especially thick over the popliteal space, where it is pierced 
by the external saphenous vein. 

Femoral Sheath. A facial investment for the femoral 
vessels, formed by the deep fascia covering Scarpa's triangle 
above, and an expansion of the internal fascial lining of the 
abdominal wall which goes down deep to the vessels, so en- 
closing them between two layers of fascia. It is divided into 
three compartments the outer one for the artery, the inter- 
mediate one for the vein, and the inner one for a lymphatic 
gland ; this latter division is known as the crural canal. 

The deep fascia of the leg is continuous with that of the thigh, 
and passing down the leg sends in septa between the muscles. 
At the ankle it is attached to the malleoli and the os calcis, and 
forms the annular ligament. 

The Internal Annular ligament is attached to the internal 
malleolus and the tuberosity of the os calcis. A number of 
important structures pass beneath it viz., tendon of tibialis 
posticus, tendon of flexor longus digitorum, post, tibial artery, 
post, tibial nerve, tendon of flexor longus hallucis. 

The External Annular ligament is attached to the external 
malleolus and the os calcis, and the tendons of peroneus longus 
and brevis pass beneath it. 

Across the front of the ankle there are usually three bands 



PLANTAR FASCIA 77 

of fascia, but occasionally more are found. The extensor 
tendons of the ankle pass beneath the uppermost one, and the 
anterior tibial vessels and nerve pass over it. 

In the sole of the foot the fascia forms the very important 
Plantar Fascia attached to the tuberosity of the os calcis ; an- 
teriorly it spreads out and divides into five slips, which are 
attached to the digital sheaths of the toes. From the sides a 
thinner layer of fascia spreads out to cover the muscles and 
sends in intermuscular septa. The plantar fascia is instru- 
mental in preserving the arch of the foot. 



SECTION IV 
VERTEBRAE, RIBS, AND MUSCLES OF TRUNK 

THE vertebrae, thirty-three in number, articulating together, 
form the spinal column. They are named according to the 
region in which they are placed : 

Cervical : 7 neck region. 

Dorsal : 12 thoracic region. 

Lumbar : 5 abdominal region. 

Sacral : 5 pelvic region. 

Coccygeal : 4 caudal region. 



Body 




Superior Articular 
Process 



t J. Spine 

<^/ 

FIG. 25. A TYPICAL VEKTEBRA. 

The vertebrae are all constructed on the same plan, but differ 
slightly from one another in the various regions according to 
their necessities. 

A typical vertebra consists of a body more or less cylindrical 

78 



VERTEBRAE 



in shape ; the sides and upper and lower surfaces are slightly 
concave. Posteriorly, two short, stout processes the pedicles 
are formed; these support flattened laminge, which fuse in the 
middle line ; thus, the posterior surface of the body, the 
pedicles, and the laminse form a bony canal through which the 
spinal cord runs. The pedicles are not as deep vertically as the 
bodies, so that between the pedicles of two adjacent vertebras 
there are spaces left the intervertebral foramina through 
which the spinal nerves emerge. Immediately in front of the 
pedicles are other processes the transverse, to which the 
muscles of the back are attached, and on the upper and lower 
surfaces of the pedicles are articular processes (four in all) for 
the articulation of the vertebrae one with another. At the 
junction of the laminae a third process is developed, called the 
spine, for the attachment of muscles. 

PRINCIPAL VARIATIONS IN VERTEBRAE OF DIFFERENT REGIONS. 



Vertebra. 


Body. 


Spine. 


Transverse Process. 


Cervical (first 
and second de- 
scribed separ- 
ately) 

Dorsal 


Oval in shape 

Heart- shape, 

with facets for 
heads of ribs 


Short and bifid 
at the free end 

Long, thin, and 
pointing down- 
wards 


Small, and with a foramen 
through which the verte- 
bral artery runs 

Have small facets for artic- 
ulation with the tubercle 
of the rib 


Lumbar 


Kidney-shape 


Short, stout, and 
horizontal 


Point horizontally out- 
wards, with several 
tubercles for attachment 
of muscles 



The Sacral vertebrae are all fused together into one bone, 
called the sacrum. 

The Sacrum is a triangular bone formed of the five sacral 
vertebra?, whose bodies and transverse processes have become 
fused together, distinct ridges being seen at the line of fusion on 
the anterior surface. 

The anterior surface is concave from above downwards, and 
has four foramina on each side of the middle line for the 
passage of nerves. These are homologous with the inter- 
vertebral foramina, and, through the fusion of the transverse 
processes with one another, appear both anteriorly and pos- 



SO HANDBOOK OF ANATOMY 

teriorly. Above, the margin is projecting, forming the promon* 
tory of the sacrum. This is more marked in the male than the 
female. 

The posterior surface is convex from above downwards, and 



Superior Articular Process 



Ala 




Inferior Lateral Angle 



4th Anterior Sacral Foramen 



FIG. 26. SACRUM (ANTERIOH SURFACE). 

has the four foramina on each side, similar to the anterior 
surface. In the middle line the spines of the vertebrae still 
persist as four tubercles. 

On each side of the upper part of the bone are the lateral 
masses, large stout masses of bone, on the external aspects of 
which are the surfaces for articulation with the innominate 
bone. 



VERTEBRAE 



81 



Superior Articular Procer.s 

Rudimentary Articular Processes (fused) Ligamentous Surface . 

, Auricular Surface 
\ \ 




Transverse Procesi *\|| n 
(rudimentary) 



Outlet of Sacral Canal _- 
Notch for sih Sacral Nerve 



2nd Posterior Sacral 
Foramen 



v Inferior Lateral Angle 



% Sacral Cornu 

FIG. 27. SACRUM (POSTERIOR SURFACE). 



Anterior Tubercle 



Odontoid Facet 



Tubercle for Transverse Ligament 
Costal Process 



f Superior Articular Process 

t Costo-transverse 
/ Foramen 



Transverse Process 




Vertebrarterial 
Groove 



Posterior Tubercle 

FIG. 28. ATLAS. 



82 



HANDBOOK OF ANATOMY 



The Coccyx consists of four rudimentary vertebras, which are- 
generally fused together, and often fused with the sacrum. 

Special Vertebrae. 

The First Cervical vertebra, or Atlas, differs from the typical 
vertebra?. It consists of a ring of bone supporting laterally, 
the lateral masses which articulate above with the condyles 
of the occipital bone, and below with the second cervical 
vertebra. Posteriorly, it has a rudimentary spine, and on the 
posterior surface of the anterior arch is a small facet for 
articulation with the odontoid peg of the axis, or second cervical 
vertebra. The transverse processes, similar to those of the- 
other cervical vertebras, are attached to the lateral masses. 

Atlantal Facec 
^ Odontoid Process 

Groove for Transverse Ligament 

Superior Articular Process 
Superior 
Notch 




I Inferior 
Notch 
Costo-trans verse Foramen 



Spine 



Lamina 



Inferior Articular Process 

FIG. 29. Axis. 

The Second Cervical vertebra, or Axis, has the odontoid! 
process projecting from the upper surface of its body, which 
articulates with the anterior arch of the atlas. The superior 
articular surfaces are large and nearly circular, to correspond 
with the inferior articular processes of the atlas. 

The Seventh Cervical vertebra is called the vertebra 
proininens owing to the spine, whiclj ends in a broad, single 
tubercle, and is markedly prominent at the root of the neck. 

The Dorsal, or thoracic, vertebras are characterized by having 
articular facets on their bodies for the heads of the ribs, and 



STERNUM 83 

on the transverse processes for the tubercles of the ribs. The 
facets 011 the bodies are usually placed midway on adjacent 
bodies, so that a demi-facet is found on the upper and lower 
margins of bodies. 

The Vertebral Column as a whole. The vertebra are so 
articulated that the bodies, transverse processes, and spinous 
processes are all superimposed. This causes posteriorly two 
longitudinal grooves, one each side of the spine, in which are 
placed the longitudinal muscles of the back. 

Viewed from the side, it is seen that the column forms 
a series of curves, slightly forward in the cervical region, 
markedly backward in the thoracic region, and forward again 
in the lumbar region. The sacrum, again, is convex backwards, 
and the junction of the fifth lumbar vertebra with the sacrum is 
called the sacro-vertebral angle, which is always very marked. 

Ossification. Centres for the bodies and neural arches appear 
before birth. At puberty, epiphyses for the different processes 
and upper and lower surfaces of the bodies appear. All become 
completely fused about the twenty-fifth year. 

The Sternum, or Breast-Bone, is in the middle of the upper 
part of the anterior wall of the thorax. It articulates on each 
side with the upper seven ribs and the clavicle. It consists of 
three parts the manubrium or presternum, the body, and the 
ensiform or xiphoid cartilage. 

The Manubrium is separate from the body, although occa- 
sionally it is found to be fused. It is a flattened, four-sided 
bone, the upper end being wider than the lower. At the 
superior angles it articulates with the first rib on each side, 
and immediately in front of this articulation on the upper 
margin are the facets for articulation with the clavicles, be- 
tween which is the suprasternal notch. At its junction with the 
body is found the articulation for the second rib. 

The Body of the Sternum is a long-shaped flat bone, with its 
f-ddes notched for articulation with the second to the seventh ribs 
inclusive. At its upper end it articulates with the manubrium, 
and at the lower end is attached the ensiform cartilage, a pointed 
process which is partly ossified. 

The Sternum lies obliquely downwards and forwards in the 



84 



HANDBOOK OF ANATOMY 



ist Thoracic 




ist Lumbar 



StC. 



istT. 



ist L. 



Sacrum 



Coccyx 

FIG. 30. SPINAL COLUMN. 



.ist Co. 



STERNUM 



85 



front of the chest. At rest its upper end is opposite the lower 
border of the second dorsal vertebra, and its lower end opposite 
that of the tenth. 



Jnterclavicular Notch 




Clavicular Surface 



Fcr ist Costal Cartilage 



FIG. 31. STERNUM. 



Ossification. Several centres are developed before birth, the 
whole becoming fused about the fortieth year. 



86 HANDBOOK OF ANATOMY 



The Ribs. 

The Ribs (costae) are twenty -four in number, twelve on each 
side. They articulate posteriorly with the dorsal vertebrae, 
and anteriorly with the sternum and one another (except the 
eleventh and twelth, which are free at their anterior ends), 
thus forming the lateral walls of the thorax. 

A rib is a long, narrow, flat bone, consisting of a head and 
neck attached to the shaft. The head is somewhat expanded, 
and has on its inner surface a facet for articulation with the 
Vertebrae, the lower half of which corresponds with the facet 
on the upper margin of the body of the vertebra corresponding 
with it, so that each rib articulates with the body of the vertebra 
with which it is in numerical sequence, and with the body of the 
one above. Thus, the seventh rib articulates with the upper 
margin of the body of the seventh vertebra and the lower margin 
of the body of the sixth. Below, the head is constricted to form 
a neck, and where it joins the shaft there is a tubercle on the 
posterior surface. The tubercle has a facet to articulate with 
the transverse process of the vertebra numerically correspond- 
ing with it. The shaft is long, flat, and narrow. It is convex 
laterally, but the curve is much sharper posteriorly than 
anteriorly, and where the curve is sharpest there is a rough, 
oblique ridge on the external surface ; this is called the angle. 
On the first rib the tubercle and angle coincide. They gradually 
separate, being farthest apart on the eighth rib, and approach- 
ing one another again on the lower ones. The shaft of the rib 
is also twisted on itself, so that, if laid on a flat surface, one end 
is always raised up. This is most marked in the middle ones, and 
not found at all in the first, second, and twelfth. The upper 
border is thick and rounded, the lower one thin and sharp, and 
on the inner surface of the lower border is a groove for vessels 
and nerves. The anterior end of the shaft is slightly expanded 
and hollowed out for the attachment of the costal cartilage, 
by means of which the ribs articulate with the sternum or one 
another. 

The first rib is much smaller than the others, quite flat, and 
forms nearly a semicircle. On its upper surface, about midway, 



RIBS 



87 



is a groove for the subclavian artery. On the inner border, about 
.an inch from the anterior extremity, is the scalene tubercle. 
The surfaces are directed upwards and downwards. 



Subcostal 
Groove \ 



Medullary - 
Foramen 



Ang 



MCCK 



^Upper Facet on Head 

.Ridge for Interarticular 
Ligament 

_ Lower Facet on Head 



Articular Part of Tubercle 
Ligamentous Part of Tubercle 




'jHead 



Sternal 
Kxtremity 



Fiu. 32. A TYPICAL RIB. 



The second rib resembles the first in shape and in having 
no twist, but is a good deal larger. The surfaces are directed 
obliquely, similarly to those of the other ribs. 



88 



HANDBOOK OF ANATOMY 



The eleventh and twelfth ribs are very much' shorter and 
smaller than the others. Their anterior extremities are pointed 
and tipped with cartilage, but are free and non-articulating. 

Ossification. The shaft is almost completely ossified before- 




FIG. 33. THORAX. 



birth. Secondary centres for the head and tubercle appear 
before puberty, and the whole rib is fused by the twenty -fifth 
year. 

The Thorax as a whole is barrel-shaped, narrower above than 



VERTEBRAL JOINTS 89 

below, and compressed antero-posteriorly. The inlet, or superior 
aperture, is kidney-shaped, its plane oblique, sloping down- 
wards and forwards. The lower aperture is curved, and slopes 
upwards along the twelfth rib to the tip of the eleventh, along 
the cartilages of the tenth, ninth, eighth, and seventh ribs 
to the ensiform cartilage. This aperture is closed by the 
diaphragm. 

Joints of the Vertebral Column. 

The vertebras articulate together by their bodies and the 
transverse processes. Each individual joint has not much power 
of movement, but, taken altogether, the range of movement of 
the spine as a whole is considerable. 

Intercentral Articulations. These take place between the 
flattened surfaces of the bodies of the vertebras. Between the 
two surfaces is a cartilaginous disc, the inter vertebral disc. In 
the cervical and lumbar region the disc is thicker in front than 
behind, and the reverse in the dorsal, thus helping to form the 
curves. 

The Anterior Longitudinal ligament runs the whole length of 
the spinal column on the anterior surface, from the first cervical 
vertebra to the upper margin of the sacrum, and is firmly 
attached to the intervertebral discs as it passes over them. 

The Posterior Longitudinal ligament resembles the foregoing, 
but is placed inside the spinal canal on. the posterior surfaces of 
thedpodies. 

Interneural Articulations. These take place between the 
articulating processes on the pedicles of adjacent vertebras. 
These are gliding joints, each surrounded by a thin capsule 
lined by a synovial membrane. In addition, the ligamenta flava 
binds together the laminas. This ligament is inside the spinal 
canal, and resembles the anterior and posterior longitudinal 
ligaments in being continuous throughout the length of the 
spinal column. 

The spinous processes are attached to one another by inter- 
spinous ligaments. In continuity with them are the supra - 
spinous ligaments, which extend all along the spinal column 
from tip to tip of the spines. In the cervical region these are 



'X) HANDBOOK OF ANATOMY 

particularly developed, forming a partition between the muscles 
of the two sides, and called the ligamentum nuchae. 

The atlas and the axis have several additional ligaments join- 
ing them together, one being a transverse ligament, which is 
attached to the dorsal surface of the anterior arch of the axis, 
and passes behind the odontoid peg of the axis. 

The spinal column as a whole is freely movable, and permits 
of movement round three axes 

Transverse flexion and extension. 

Antero-posterior lateral flexion. 

Vertical rotation. 



Posterior Band of Superior 
Costo-transverse Ligament 
Anterior Band of Superior 

Costo-transverse Ligament 




_ . Anterior Common 
Ligament 



_Inlerverttbral 



Anterior Costp-central ' 
or Stellate Ligament I 



Interarticular Ligament 



FIG. 34. VERTEBRAL LIGAMENTS. 

The articulations of the ribs, both with the vertebra) and the 
sternum, are by means of gliding joints, which allow the ribs 
to be raised and lowered by the muscles to perform the act of 
"breathing. 

Muscles of Trunk. 

The actions of the muscles of the trunk are very complex. 
They are arranged in two main sets 
Muscles of the back. 
Muscles of the abdominal wall. 



MUSCLES OF BACK 



91 



The Muscles Of the Back can again be divided into transverse 
-and longitudinal. The transverse muscles are those which 
connect the shoulder girdle with the spinal column, and the 
longitudinal ones those that cause extension of the back and 



Complexus 



Cervicahs Ascendens,._ 




Splenius 



Serratus Posticus Superior 



..Vertebral Aponeu- 
rosis 



Musculus Accessorius .-J, 



Longissimus Dorsi 



Ilio-costalis,. 



.. Serratus Posticu 
Inferior 



FIG. 35. MUSCLES OF THE BACK. 

the movements of the pelvis (as in locomotion), which corre- 
spond with those of the spinal column. The movements of 
the head on the spinal column will be considered in another 
section. 

The muscles are arranged in four layers. Starting with the 
most superficial they are 



HANDBOOK OF ANATOMY 



1. Trapezius and latissiinus dorsi. 

2. Levator anguli scapulae and rhomboids. 

3. Serrati postici superior and inferior, splenius capitis 
splenius cervicis. 

4. Erector spinae and complexus. 



Pectoralis Major 



Serratus Magnus 



Latissimus Dorsi . 



Obliquus Externus 
Abdominis 



Petit's Triangle 




~ Middle Linea 
Transversa 



Umbilicus 



'^..Umbili 



Rectus Abdominis 



Anterior Superior 

Iliac Spine 



.Poupart's Ligament 



"External Abdominal 
Ring 



FK;. 36. MUSCLES OK THE ABDOMEN. 



Beneath these muscles are a larv number of smaller ones 
that move the vertebrae on one another e.g., rotatores, inter- 
spinals, etc. 



MUSCLES OF BACK 



93 



The Muscles of the Abdomen are arranged in three directions 
longitudinal, transverse, and oblique. The longitudinal ones 
straight up the front, flex the trunk, helped by the oblique ones 
when both sides act together. When the oblique muscles act 
singly, rotation of the trunk takes place. The longitudinal 
muscles on the posterior wall of the abdomen extend the spme~ 
when both act together. Acting singly, they flex the spine 
laterally. The transverse muscles of the abdominal wall are 
mainly used to keep the contents of the abdomen in place and 
to add to the strength of the wall, but help in flexion with the 
others. 

Some of the muscles causing flexion and extension of the 
cervical part of the spine are situated in the neck and attached 
to the head ; these must not be confused with the muscles that 
specially move the head on the spine. 

(For Flexion and Extension of Spinal Column, see pp. 94 
and 95.) 

The movement of lateral flexion of the spinal column takes 
place by the muscles of flexion and extension acting together 
on one side. In the cervical region, however, there are a group 
of muscles which cause lateral flexion of that part. 



Artiun. 


Muscle. 


< )rigin. 


Insertion. 


Nerve-supply. 


Lateral 
flexion 


Scalenus 
anticus 


From the transverse 
processes of the third, 
fourth, fifth, and sixth 
cervical vertebrae 


The scalene tubercle 
and ridge -on the first 
rib 


Anterior 
primary 
divisions of 
lower four 
or five cervi- 
cal nerves 




Scalenus 
medius 


From the transverse 
processes of the lower 
cervical vertebra- 
(second to sixth in- 
clusive) 


On the first rib behind 
the groove for the 
subclavian artery 


Same as 
above 




Scalenus 
posticus 


From the transverse 
processes of the fourth, 
fifth, and sixth cervi- 
cal vertebra; 


The outer surface of the 
second rib about the 
middle 


Same :is 
above 



94 



HANDBOOK OF ANATOMY 



MUSCLES (BOTH SIDES TOGETHER) ACTING ON THE 
SPINAL COLUMN. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Flexion 


Longus 


From the bodies and 


The bodies and trans- 


Anterior 




colli 


transverse processes 
of the first three 


verse processes of the 
upper cervical verte- 


primary 
divisions of 






thoracic and last th ree 


L 

brae 


the upper 






cervical vertebra 




cervical 










nerves 




Psoas 


See Hip-Joint 








Rectus 


By two heads from the 


The front of the ensi- 


Anterior 




abdominis 


symphysis and crest 


form cartilage and 


primary 






of the pubis 


seventh, sixth, and 


divisions of 








fifth costal cartilages 


the lower 










six thoracic 










nerves 




Obliquus 
externus 


From the outer surfaces 
of the lower eight ribs 


The external lip of the 
iliac crest in its 


Same as 
above 




abdominis 


interdigitating with 


anterior half and into 






(external 


serratus magnus and 


a broad aponeurosis 






oblique) 


latissimus dorsi 


covering the anterior 










abdominal wall. By 










this means it is 










attached to the pubic 










crest, and the lower 










free edge of the 










aponeurosis forms 










Poupart's ligament 






Obliquus 


From the lumbar fascia, 


The outer surfaces of 


Same as 




internus 


the anterior half of 


the last three ribs, and 


above 




abdominis 


the iliac crest, and 


forming an aponeuro- 






(internal 


the outer half of Pou- 


sis into the seventh, 






oblique) 


part's ligament 


eighth, and ninth 










costal cartilages and 








- 


linea alba 






Trans- 


From the inner surfaces 


The fibres form an apo- 


Same as 




versalis 


of the lower six costal 


neurosis, which joins 


above 






cartilages interdigi- 


with that of the other 








tating with the dia- 


side to form the linea 








phragm ; the lumbar 


alba ; and below joins 








fascia, anterior half of 


the lower part of the 








internal lip of iliac 


obliquus internus to 








crest, and outer third 


form the conjoint ten- 








of Poupart's ligament 


don attached to the 











crest of the pubis 





MUSCLES OF BACK 



95 



MUSCLES (BOTH SIDES TOGETHER) ACTING ON THE SPINAL 
COLUMN Continued. 



Action. 


Muscle. Origin. 


Insertion. 


Nerve-supply. 


Exten- 


Com- From the transverse 


Between the superior 


Posterior^ 


sion 


plexus processes of the upper 
six thoracic and lower 


and inferior" curved 
lines of the occipital 


primary 
divisions of 




four cervical vertebrae 


bone near the middle 


the spinal 






line 


nerves 




Splenius | From lower half of liga- 
capitis mentum nuclue and 


Splenius capitis into the 
mastoid process and 


Same as 
above 




and spines of seventh cer- 
cervicis vical and upper six 


outer part of superior 
curved line of occipi- 








dorsal A^ertebrre 


tal bone ; splenius 










cervicis into the trans- 










verse processes of the 










upper cervical verte- 










brae 






Serratus 


From the ligamentum 


By slips into the second, 


Same as 


posticus 


uuchae and spines of 


third, and fourth ribs 


above 


superior 


seventh cervical and 








tirst four dorsal verte- 








brae 






f 








, 








Serratus 


From the spines of the 


By slips into the last 


Same as 


posticus 


last two thoracic and 


four ribs 


above 


; inferior 


first two lumbar verte- 








brae 






Erector 


From the posterior half 


Divides into three por- 


Same as 




spinee 


of the iliac crest, the 


tions : (1) Ilio-costa- 


above 






posterior sacro - iliac 


lis, by slips into the 






ligament, the back of 
the sacrum, and spines 


lower six ribs ; (2) the 
longissimus dorsi, by 






of all the sacral and 


outer slips into all the 






lumbar vertebra 


ribs and inner slips 








into the transverse 








processes of the upper 










lumbar and all the 










dorsal vertebrae ; (3) 








spinalis dorsi, into the 








spines of the upper 










dorsal vertebrae 






Quadra.tus Posterior part of iliac 


Inner part of lower 


First three 




lumborum' crest, ilio-lumbar liga- 


border of twelfth rib, 


or four 




ment, and transverse 


and transverse pro- 


lumbar 






processes of the lower 
lumbar vertebra? 


cesses of upper lumbar 
vertebrae 


nerves 



96 



HANDBOOK OF ANATOMY 



Poupart's ligament the thickened free edge of the external 
oblique muscle from the anterior superior spine of the ilium to 
the spine of the pubis. 

The movement of rotation of the spinal column can be 
defined as the approximation of the twelfth rib of the one side 
to the iliac crest of the other. It is carried out by the diagonal 
: muscles of the trunk. Thus rotation to the left i.e., turning 
the body so tha"t the right twelfth rib is brought nearer to the 
left iliac crest, is caused by the following muscles : 

Right obliquus externus abdommis. 

Left obliquus interims abdominis. 

Left latissimus dorsi. 

Left serratus posticus inferior. 

Rotation to the right, by the opposite muscles acting together. 
This movement is made possible by the directions of the fibres 
of the muscles concerned, and the fact that the external oblique 
muscle of each side is inserted into the ivhole of the pubic crest, 
so that the right external oblique gets some of its fibres inserted 
into the left pubis, and vice versa, consequently is able to pull 
its own side of the trunk over to the other. 

Muscles of the Thorax. 

This group of muscles can equally well be called the muscles of 
respiration, as they are the ones that raise the ribs or otherwise 
enlarge the cavity of the thorax, and make respiration possible. 



Muscle. 



Origin. 



Diaphragm From the ventral surface of 
the ensi form cartilage ; from 
I the ventral surfaces of the 
cartilages of the lower six ribs 
interdigitating with trans- 
versalis ; by two crura from 
the fronts of the bodies of 
the upper lumbar vertebrae 
three on the right side, two 
on the left which decussate 
in front of the aorta ; and 
from the arcuate ligaments, 
which are thickenings in the 
fascia covering psoas and 
quadratus lurnborum 



Insertion. 



It is inserted into a 
large trilobed central 
tendon, which is de- 
veloped in the muscle 
itself, and has no 
bony attachment 



Nerve-supply. 



Phrenic 



INTERCOSTAL MUSCLES 



97 



Inspiration, caused by the elevation of the ribs and depression 
of the diaphragm. 

The intercostal muscles fill up the spaces between the ad- 
jacent ribs. They are arranged in two sets, external and internal, 
eleven pairs of each. 

Expiration, caused by the slackening of the muscles, the 
weight of the thorax, and the elasticity of the lungs. The 
triangularis sterni is a special depressor of the ribs, and some 
anatomists consider the internal intercostal muscles to be so 
also. 




Internal Mammary 
Artery 



External Intercostal Muscle 



Interchondral Part 

cf Internal 
Intercostal Muscle 



External Intercostal Muscle 



Interosseous Part of Internal 
Intercostal Muscle 



FIG. 37. INTERCOSTAL MUSCLES. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve- supply. 


Inspira- 
tion 


External 
intercostal 


From the lower border 
of the rib between the 
tubercle and the costal 
cartilage. The fibres 
go downwards and 
forwards in series with 
the fibres of the ex- 
ternal oblique 


The upper border of the 
rib below from the 
tubercle to the costal 
cartilage 


Intercostal 


The 


space in fr 


ont over the costal cartil ages is tilled by the ante 
intercostal aponeu rosis 


rior 



98 



HANDBOOK OF ANATOMY 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Inspira- 


Internal 


From the lower border 


The upper border of the 


Intercostal 


tion 


intercostal 


of the costal carti- 


rib below from the 




(contd.) 




lage and inner edge of 


sternum to the angle 








the subcostal groove ; 


of the rib 








from the sternum to 










the angle of the rib. 










The fibres go down- 










wards and backwards 










in series with the 










fibres of the internal 










oblique 




[ 


The 


space beh 


ind, between the angles 


and the tubercles of the 


ribs, is filled; 






by the posterior intercos 


tal aponeurosis 
















Scaleni 


See Back Muscles 








Serrati 


See Back Muscles 








postici 








Depres- 
sors of 


Triangu- 
laris 


From the back of the 
4hsiform cartilage and 


The cartilages of the 
second to sixth ribs 


Intercostal 


the ribs 


sterni 


sternum as high as 


inclusive 




in expi- 




the third costal carti- 






ration 




lage. 








Internal 


See above 








intercostal 










Abdomi- 


See Flexion of Spinal 








nal 


Column 








muscles 









Several other muscles are used in acts of extraordinary or 
forced inspiration, namely : 

Quadratus lumborum. 
Pectorales major and minor. 
Serratus magnus. 
Latissimus dorsi. 
Sterno-mastoid . 
^Extensors of the back. 

The Deep Fascia of the trunk forms a complete investment 
for all the muscles. In the upper part of the body it is similar 
to the deep fascia of the limbs, forming an outside covering, and 
sending in septa between the muscles ; but in the lumbar and 
abdominal regions it is rather more complicated. 



LUMBAR FASCIA 99 

The Lumbar Fascia is attached to the lumbar vertebrae in 
three layers the outermost layer, to the spines ; the middle 
layer, to the transverse processes; the innermost layer, to the 
bodies, near the roots of the transverse processes. 

The outermost layer covers the dorsal surface of erectpr_ 
spinae. 

The middle layer lies between erector spinae and quadra tus 
lumborum. 

The innermost layer covers the ventral surface of quadratus 
lumborum. 

The middle layer then splits into two, so that four layers of 
fascia are formed for the three layers of abdominal muscles. 

1. Covers the outer surface of external oblique. 

2. Lies between external and internal oblique. 

3. Lies between internal oblique and transversalis. 

4. Covers -the inner surface of transversalis. 

At the outer border of rectus abdominis these four layers 
now join again to form two layers, which pass one in front of, 
the other behind, rectus abdominis, forming what is called the 
sheath of the rectus ; this takes place in the upper three- 
fourths of the muscle. In the lower fourth both the layers of 
fascia pass in front of the rectus, so that on its ventral surface 
three-fourths of the way down there is a free edge of fascia, 
known as the fold of Douglas. 



SECTION V 

P 

BONES AND MUSCLES OF HEAD 

THE term skull includes all the bones making up the head. This 
comprises the bones which enclose the brain i.e., the cranium, 
and the bones composing the skeleton of the face. 

The bones of the cranium are The occipital, sphenoid, 
ethmoid, frontal, the two parietals, and the two temporals. 

The bones of the face are The vomer, the mandible, and 
pairs of maxillae, malar, palate, lachrymal, nasal, and inferior 
turbinate. 

The hyoid bone is usually described with those of the skull. 

All the bones of the head and face are joined together by 
immovable joints (sutures), except the mandible. 

The skull, as a whole, is studied from five aspects from 
the front, the side, the back, the top, and the base. 

Norma Frontalis the skull viewed from the front. This 
is limited above by the smooth convex upper part of the frontal 
bone, and below by the teeth of the upper jaw, if the mandible 
be disarticulated. The eye-sockets are formed by the lower 
part of the frontal bone, which in the middle articulates with 
the two nasal bones to form the bridge of the nose. The 
lower border of the eye-sockets is formed, internally, by the 
maxillae and externally, by the malar bones, which give promi- 
nence to the cheeks. The two maxillae articulate in the middle 
line below the nasal opening, to form the upper jaw; below 
hangs the mandible, or lower jaw, which articulates on each 
side by a very loose joint with the temporal bone. 

Nopma Lateralis (the side view of the skull). In this view 
it can be seen distinctly which bones form the face and which 
the cranium. A line drawn from the middle of the lower border 

100 



NORMA LATERAL!^ L ; 101 

of the frontal bone to the mastoid process of the temporal bone 
indicates the boundary. The cranium is of oval shape, with 
the long axis going backwards and downwards. The bones 




FIG. 38. THE LATERAL REGION OF THE SKULL (NORMA LATERALIS). 
I, I, Frontal ; II, II, Parietal ; III, Occipital ; IV, Great Wing of Sphenoid ; 

"\T Q^ti^i wts-vii.-* 1>^%,4-C^ r T^ .t._1 . "\fT tf j_ *J T_ A f m 




1, Bregma ; 2, Superior Temporal Ridge ; 3, Inferior Temporal Ridge ; 4, Occipital 
Point ; 5, Auricular Point ; 6, Mental Foramen ; 7, Lachrymal Groove ; 
8, Glabella. 

composing 'it from before backwards, are The frontal, parietal, 
temporal, and occipital. In this view it can also be seen that 






10_> LHAHD1300K OF ANATOMY 



the malar articulates with a process of the temporal. Between 
this process and the opening of the ear is the articulation of 
the mandible. 

Norma Oceipitalis (the back view of the skull) shows the 
rounded shape of the back of the head and the joints of the 
occipital and parietal bones, called the lambdoid suture. 

Norma Vertiealis (the view of the skull from above). This 
varies very much with different individuals, and may be nearly 
circular or a long oval. The T-shaped sutures of the large 
bones forming the vault is seen : the two parietal bones join in 
the middle line ; and anteriorly, where the parietals join the 
frontal, and posteriorly, where the parietals join the occipital, 
are situated the openings called the anterior and posterior 
fontanelles, found on the head at birth. These are due to the 
ossification of the several bones not being complete. 

Norma Basalis (the view of the base of the skull, without the 
mandible). In front is seen the row of upper teeth, between 
them being the processes of the maxillae forming the roof of the 
mouth. Behind this is the sphenoid bone which, as it were, bolts 
together the whole skull underneath. The pterygoid plates, 
two on each side, hang down for the attachment of muscles, 
and the great wings of the sphenoid pass out on each side to 
articulate with the temporal bones. Articulating with the body 
of the sphenoid bone is the basilar process of the occipital bone, 
and behind this is seen the opening for the passage of the 
spinal cord. On each side of the opening are the prominent 
articular facets for articulation with the first vertebra. There 
are numerous foramina on the base of the skull for the passage 
of the cranial nerves. 

The Frontal bone consists of three parts : a frontal part, 
forming the forehead; an orbital part, forming the upper 
margins of the eye-sockets; and a nasal part which helps to 
form the bridge of the nose. 

The frontal part is convex in both its diameters, most marked 
just above the orbital margins. 

The orbital part consists of the two rounded margins, separated 
from one another by the nasal notch. At the inner third of the 
margin is a deep groove, or may be a foramen, for the passag'e of 




FIG. 39. THE EXTERNAL BASE OF THE SKULL. 



Ant. Palatine Fossa 18. 

Post. Nasal Spine 19. 

Post. Border of Vomer 20. 

Facial Surf, of Sup. Maxilla 21. 

Hamular Process of Int. Pterygoid 22. 

Plate of Sphenoid 23. 

Pterygoid Fossa 24. 

Ext. Pterygoid Plate 25. 

Zvgomatic Process of Malar 26. 

Zygoma of Temporal 27. 

Pharyngeal Tubercle (pointer 28. 

crosses Foram. Lacerum Med.) 29. 

Eustachian Groove 30. 

Groove for Chorda Tympani ji. 

Nerve 

Petrous Portion of Temporal (Ori- 32. 

gin of Levator Palati) 33. 

Carotid Foramen 34. 

Ext. Auditory Meatus 35. 

Ext. Auditory Process 36. 
Basion 



Bas 



Mastoid Process 

Jugular Foramen 

Ant. Condvlar Foramen 

Digastric Groove 

Occipital Groove 

Post. Condvlar Foramen 

Sup Curved Line of Occipital 

Inf. Curved Line 

Ext. Occipital Crest 

Ext. Occipital Protuberance 

Opisthion 

Foramen Magnum 

Right Occipital Condyle 

Foram. Lacerum Medium 

at + 

Vaginal Proc. of Tymp. Plate 
Mastoid Foramen 
Stylo- Mastoid Foramen 
Styloid Process 
Tympanic Plate (Tost, part of 

Glenoid Fossa) 



37. Spii'ous Proc. of Sphenoid 

38. Ant. part of Glenoid Fossa 
*39 V Foramen Spinosum 

46". ^Foramen Ovale 
\fj.' Foramen Vesalii 

42. Preglenoid Tubercle 

43. Eminentia Articularis 

44. Zygomatic Fossa 

45. Iniratemporal Crest 

46. Temporal Division of Great 

Wing of Sphenoid 

47. Spheno-Maxillary Fissure 

48. '1 uberosity of Sup. Maxilla 

49. Ext. Access. Palat. Foramen 

50. Post. Access. Palat. Foramen 

51. Post. Palatine Foramen 

$2'. Right Post. Naris (pointer crosses 
ridge for Tensor Palati) 

53. Groove for Descend. Palat. Artery 

54. Horiz. Plate of Palate Bone 

55. Palat. Proc. of Sup. Maxiiia 



104 



HANDBOOK OF ANATOMY 



the supra-orbital nerve ; the margins end in the external angular 
processes. 

The nasal part is roughened and projects backwards for the 
articulations of the nasal bones and other bones which are inside 
the face. 

The frontal bone articulates with the parietal bones above, 



Parietal Border 



Superior Temporal Ridge 



Inferior 
Temporal Ridge 



Frontal Eminence 



Temporal Surface for 
Temporal Muscle 




\ 

N External 
Angular Process 



Lachrymal Fossa 



Glabella / J 
Nasal Process 



\ n 

i Superciliary Rjdge 
Supra : pi'bltal Notch 



Nasal Sni-* 

FIG. 40. THE FRONTAL BONE. 

with the malar bones by the outer extremities of the orbital 
margins, with the great wing of the sphenoid externally, just 
beyond the orbital margins. 

The Parietal bones are two square-shaped bones, convex 
outwardly in both diameters. They articulate above with one 
another, anteriorly with the frontal bone, posteriorly with the 
occipital bone, and below with the temporal and sphenoid 
bones. 



OCCIPITAL BONE 



105- 



The Occipital bone consists of three parts arranged around 
the foramen magnum a large hole for the passage of the spinal 
cord. The posterior part is triangular in shape, the apex being 
upwards, and is convex outwardly in both diameters. About the 
centre of this surface is a tubercle the external occipital protu- 

Upper or Interparietal part 
of Tabular Portion 

External Occipital Crest 1 ^External Occipital Protuberance 

Highest Curved Line", \ 1 / / Superior Curved Line 

^ Y / ^>^ 

Inferior Curved Line 




Lateral Angle 



Inferior Lateral 

Border of 
Tabular Portion 



v Jugular Process 



Posterior Condylar Fossa and 
Foramen (latter inconstant) 
Anterior Condylar Foramen 



Pharyn?eal Tubercle on 
Basilar Process 

FIG. 41. THE OCCIPITAL BONE. 



berance and from this curves out on each side the superior 
curved lines; a short distance below are the inferior curved 
lines. On each side of the foramen magnum are the condyles 
for articulation with the atlas. They are large oval masses 
of bone with an articulating surface convex in both directions - r 



106 



HANDBOOK OF ANATOMY 



in front and behind are found the anterior and posterior con- 
dylar foramina, the former of which transmits the hypoglossal 
nerve. The basilar process, in front of the foramen magnum, 
is a stout bar of bone articulating with the body of the 
sphenoid. 

The occipital bone articulates with the two parietals above, 
with the sphenoid in front and below, externally with the 
temporals, and below with the atlas. 

, Squamous Portion 



Supramastoid Crest 
Parietal "Notch \ 



Post. Root of 
Zygoma 




JVlastoid" Foramen 



Mastoid Portion 



External Auditory Meatus 



Ant. Part of Glenoid Fossa 



Post. Part of Glenoid Fossa 
(Tympanic Plate) 



Styloid Process 

FIG. 42. THE RIGHT TEMPORAL BONE. 

The Temporal bone consists of a plate of bone, having on its 
lower border three processes. The inner part of the temporal 
bone supports the bony part of the ear, the aperture of which 
is seen just behind the root of the zygomatic process at the 
lower border of the squamous part (flat plate). The zygomatic 
process is a bar of bone projecting horizontally forwards. Just 
in front of the root is the surface for articulation with the 



SPHENOID BONE 107 

mandible and internal to the root ; the styloid process, a slender 
process of bone, projects vertically downwards. The mastoid 
process is a stout conical-shaped process behind the opening of 
the ear, its apex pointing forwards and downwards. 

The temporal bone articulates by means of the upper border 
of the squamous part with the sphenoid (great wing), parietal^ 
and occipital bones, and by the zygomatic process with the 
malar bone. 

The Sphenoid bone consists of a small body with several 
paired processes, the important ones being the great wings and 
the pterygoid plates. The latter, four in number, project 
downwards behind the nose. The great wings have at their 
extremities triangular surfaces, which articulate with the 
frontal, parietal, and temporal bones ; these lock the sides of the 
cranium anteriorly. The body lies between* the ethmoid (which 
articulates with the nasal parts of the frontal bone) and the 
basilar process of the occipital bone, so locks the cranium in 
the antero-posterior direction. The great wings also form part 
of the orbital cavity, and between the great wing and the lesser 
wing is the sphenoidal fissure at the back of the orbital 
cavity through which the first part of the fifth nerve passes. 
The foramen rotundum and foramen ovale are in the great 
wing. 

Bones of the Face. 

The MaxillSB unite to form the upper jaw; the body is pyram- 
idal in form, and hollow, and has on it the infra-orbital foramen, 
through which part of the fifth nerve emerges. On the anterior 
border is a deep notch the nasal notch ; above the nasal notch 
the edge of the bone is rough to articulate with the nasal and 
frontal bones, below which it unites with its fellow of the 
opposite side. The inferior or alveolar border is ridged ex- 
ternally, and from it project the upper row of teeth; on the 
inner surface the palatal process, a flat plate of bone, projects 
horizontally inwards to form the roof of the mouth. The 
upper border is smooth and rounded, and forms the inner 
half of the lower border of the orbjtal margin, and ends in 
a rough process for articulation with the malar bone ; the pos- 



108 



HANDBOOK OF ANATOMY 



terior border is smooth and rounded, and hangs free at the 
back of the mouth. The hollow space enclosed is called the 
antrum of Highmore. 

The maxilla articulates with the nasal, frontal, and malar 
bones, and its fellow of the opposite side. 

The Malar bone, or cheek-bone, forms the most prominent 
part of the cheek ; the bone is convex outwardly and more or 



Nasal Process 
For Lachrymal Bone 



For Nasal Bone 



Lachrymal Tubercle 

Lachrymal Notch 
Orbital Surface 



Infra-orbital Groove 



Openings of , 
Post Dental Canals 



._ Nasal Notch 




-.Anterior Nasal 
Spine 



Tuberosity 

Zygomatic Surface 4 

I 

Malar Process 



Palatal Process 



1 Canine Fossa 
Infrn.orbital Foramen 

FIG. 43. THE SUPERIOR MAXILLA. 

less square in shape, three of the angles being prominent. The 
superior angle articulates with the external angular process of 
the frontal bone, and the upper half of the inner side of the 
malar bone forms the outer half of the lower border of the 
orbital margin ; the lower half of the inner border articu- 
lates with the maxilla : the fourth angle articulates with the- 



MANDIBLE 



109 



zygomatic process of the temporal bone, completing the 
arch. 

The Mandible, forming the lower jaw, is horseshoe in shape, 
with vertical processes at the ends. The body supports on its 
upper border the lower row of teeth, and near the middle line 
on the outer surface is the mental foramen through which the" 
mental nerve emerges. In the middle line of the body a faint 
ridge can be seen, the symphysis, indicating that the bone was 
developed in two halves and fused in the middle line. On the 



Left 



Left Condyle 



Condylar 
Tubercle 



Impression for Temporal 
Muscle 



Incisor Fossa 



AJental Protuberance ,' 
Mental Tubercle 




Posterior 
--Border of Ranms 



Angle 



Mental Foramen 

FIG. 44. THE INFERIOR MAXILLA (MANDIBLE). 

inferior border on each side of the symphysis is the digastric 
fossa, a small concave surface for the digastric muscle, and on 
the inner surface of the bone is found an oblique line or ridge, 
the mylo-hyoid ridge, slanting from above downwards and 
forwards. 

The posterior vertical portions are called rami; they pass 
upwards from the posterior extremities of the body of the bone 
forming the angle of the jaw, which varies with different 



110 HANDBOOK OF ANATOMY 

individuals. On the inner surface of the bone is a large foramen 
for the inferior dental nerve, and overhanging it a small spur 
of bone, called the lingula. The ramus ends above in two 
processes the coronoid anteriorly and the articular condyle 
posteriorly. Between them is a notch the sigmoid notch. 

The mandible articulates with the temporal bone. 

The Hyoid bone is a small U-shaped bone lying between the 
mandible and the larynx, and connected to the skull by liga- 
ments from the styloid process of the temporal bone ; it is not 
articulated with any bones. 

The bone cpnsists of a small body with two large processes,, 
the great cornua projecting backwards and, where the great 
cornua join the body, two small pointed processes, the lesser 
cornua, projecting obliquely upwards. 

The hyoid bone has a large number of muscles attached to it,, 
and owing to its loose connection with the skull gives great 
mobility to this region. 

Joints of the Skull. 

All the joints of the head and face, with the exception of the 
temporo-mandibular, are sutures. These are immovable joints 
formed by dentated edges fitted together and firmly united by 
means of cartilage. 

Temporo-Mandibular Joint between the condyle of the man- 
dible and the articular hollow at the root of the zygomatic 
process of the temporal bone. 

The joint is a very movable one, the condyle being almost 
cylindrical in shape, with its long axis directed outwards and 
forwards. The articular or glenoid fossa is saddle-shaped, 
being concavo-convex from behind forwards. The joint is 
divided into an upper and lower part by a meniscus of fibro- 
cartilage, which compensates for the difference in shape of the 
two surfaces. 

Owing to this construction the joint is particularly movable, 
and the two joints need not always act simultaneously, but can 
do so alternately, which gives a lateral movement to the jaw. 
The movements possible are 

Transverse axis raising and depressing of mandible. 



TEMPORO-MANDIBULAR JOINT 



111 



During depression protrusion and retraction. 

Alternate lateral motion. 

A combination of all these movements produces a rotatory 
movement of the jaw. 

Ligaments. A capsule surrounds the joint completely, but 
internally it is very thin; it is attached to the meniscus all 
round. 

Temporo-Mandibular ligament from the outer half of the lower 
border of the zygoma to the posterior border and lateral 



Capsular Ligament 



Styloid Process 




Zygoma 
- Coronoid Process 



- Spheno-mandibular 

(Internal Lateral) 

Ligament 



Stylo-mandibular Ligament - 



Mylo-hyoid Groove 

FKJ. 45. THE TEMPOKO-MANDIBULAR JOINT. 

surface of the neck of the mandible (the part supporting the 
condyle) . 

A synovia! membrane lines both compartments of the joint, 
which may be continuous through a perforation in the cartilage. 

Accessory Ligaments : Spheno-mandibular from the spinous 
process of the great wing of the sphenoid bone to the lingula 
on the inner surface of the mandible. 

Stylo-Mandibular, from, the tip of the styloid process of the 
temporal bone to the posterior border of the angle of the 
mandible. 



.12 HANDBOOK OF ANATOMY 

Articulation of Skull with Spinal Column. 

The skull articulates with, the spinal column by means of the 
condyles of the occipital bone and the articular facets on the 
lateral masses of the atlas. The condyles are convex in both 
lateral directions, and the facets concave, so the joint is freely 
movable round two axes. 

Transverse flexion and extension. 

Antero-posterior lateral flexion. 

A combination of these movements causes rotation or "rolling." 

A capsule, which is complete, surrounds both the joints. 

A synovia! membrane lines both the joint cavities. 

Accessory Ligaments. These are very numerous and more 
important than the ligaments of the actual joints. 

Odontoid ligaments, are three in number, one from the apex of 
the odontoid peg and one on either side; these latter are called 
check ligaments. 

Occipito-Atlantoid ligaments, anterior and posterior ; their 
membranous structure continuous with the capsules of the 
joints, thus forming a complete ligament between the foramen 
magnum and the anterior and posterior arches of the atlas. 

Posterior Occipito-Axoid ligament, a continuation upwards of 
the posterior longitudinal ligament. 

Ligamentum Cruciatum, a cross- shaped ligament, the hori- 
zontal part formed by the transverse ligament of the atlas, the 
vertical bars being attached to the occipital bone and axis 
respectively. 

Muscles acting 1 on the Joints of the Skull. 

The muscles of the head and face are divided into four sets : 

1. Muscles of the scalp. 

2. Muscles of expression. 

3. Muscles of mastication. 

4. Muscles connecting the skull to the spinal column. 

1: The Muscles of the Scalp are the occipito-frontalis muscle 
:and the muscles of the external ear. 

The OeeipitO-Frontalis muscle does not act on any joint. 



MUSCLES OF MASTICATION 



113 



The posterior part of the muscle fibres, arising from the outer 
two-thirds of the superior curved line of the occipital bone, 
are inserted into the epicranial aponeurosis; the anterior part 
arises from the epicranial aponeurosis and blends with muscles 
round the orbital margins. 

The epicranial aponeurosis is a thick fascial membrafio 
^attached posteriorly to the superior curved lines of the occipital 
bone, laterally to the temporal bone ; anteriorly, it blends with 
t*he deep fascia. 

Nerve-supply facial. 

2. The Muscles of Expression are a large number of small 
muscles in the face which generally have bony origins, but are 
inserted into the fascia or blend with other muscles ; they are 
in three groups, associated with the eye, the nose, and the 
mouth. 

Nerve supply facial. 

3. The Muscles of Mastication are those acting on the 
temporo-mandibular joint, causing movement of the lower jaw ; 
the muscles which depress the lower jaw are muscles of the 
neck, not true muscles of mastication. 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 


Raising 


Masseter 


From the anterior two- 


The outer surface of the 


Inferior 


or 




thirds of the lower 


ramns and angle of 


maxillary 


closing 




border of the zygoma 


the lower jaw 


division of 


of the 




and the inner surface 




the fifth 


jaw 




in its whole length 








Temporal 


The whole of the tem- 


The inner surface and 


Same as 






poral fossa and fascia 


apex of coronoid pro- 


above 






covering it 


cess and anterior bor- 










der of the ramus of 




J 






the lower jaw 






Internal 


From the inner surface 


The inner surface of the 


Same as 




pterygoid 


of the external ptery- 


angle of the lower jaw 


above 






goid plate and from 










the tuberosity of the 










maxilla 






; Protra- External From the under surface 


The anterior border of 


Same as 


sion 


pterygoid 


of the great wing of 


the neck of the lower 


above 






the sphenoid and the 


i jaw, the inter-articu- 






. 


outer surface of the 


lar cartilage, and the 








external pterygoid 


capsule 








plate 








Internal 


See above 






pterygoid 









114 



HANDBOOK OF ANATOMY 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve-supply. 











~ - 


Protru- 


Temporal 


From the under surface 






sion 


(anterior 


of the great wing of 






(contd. ) 


fibres) 


the sphenoid and the 










outer surface of the 










external pterygoid 










plate 






Retrac- 


Temporal 


See above 






tion 


(posterior 










fibres) 








Lateral 


External 1 








move- 


( 
r 


Pterygoid of one side 






ment 


Internal J 









The Buccinator muscle is also a muscle of mastication, but has 
no action on the jaw ; it is the muscle of the cheek, and by its 
contraction prevents food from collecting on one side. 



Muscle. 


Origin. 


Insertion. 


Nerve-supply, 


Buccinator 


From the alveolar arches 
of the upper and lower 
jaw and from the pterigo- 
mandibular ligament 


The fibres pass forward and 
blend with the muscles 
round the mouth 


Branches 
from both 
fifth and 
seventh 
nerves 



MUSCLES OF THE NECK WHICH DEPRESS THE LOWER JAW 



Action. 


Muscle. 


Origin. 


Insertion. 


Nerve -supply. 


Depres- 
sion 


Digastric 


Posterior belly from the 
digastric groove in 
front of the mastoid 


The oval impression on 
the lower border of 
the mandible close to 


Branch 
from 
inferior 






process. This ends' in 


the symphysis 


dental 






a tendon which is 










connected by a band 










of fascia to the body 










of the hyoid bone. 










The anterior belly 










arises from this, and 










is directed forwards 










and upwards 








Suprahyo 


id muscles i.e., those w 
jaw, and are inserted in 


hich have their origin^ o 
to the hyoid bone 


n the lower 



4. The muscles causing Movements of the Head i.e., those 
connecting the skull to the spinal column. 

(1) Flexion and extension the muscles of both sides acting 
together. 



MOVEMENTS OF HEAD 



115 



Action. 


Muscle. 
Depressor 


Origin. * Insertion. 


Nerve-supply. 


Flexion 


|s of the jaw when tempo ro-mandibular joint is fix 


ed 




Infrahypi 

Recti capi 
on the ] 


d muscles i.e., between hyoid bone and sternum 

tis antici major and min or, small muscles having 
esser cervical vertebrae a nd their insertions on th 
process of the occipital bone 


their origins 
e basilar 


Exten- 
sion 


Sterno- From the anterior sur- 
mastoid j faceofthemanubrium 
sterni and the inner 
third of the upper 
border of the clavicle 


The outer surface of the 
mastoid process and 
the superior curved 
line of the occipital 
bone 


Spinal 
accessory 




Splenius 
capitis 


See Extension of Spinal 


Column 






Com- 
plexus 


See Extension of Spinal 


Column 






Obliquus 
inferior 


From the spine of the 
axis 


The transverse process 
of the atlas 


Post 
primary 
divisions 


Kectus ca 
atlas 


pitis posticus major and 
to the occipital bone be 


minor from the spine of 
hind the foramen magn 


the axis and 
um 



(2) Lateral movement the muscles of one side acting alone. 



Action. 

Lateral 
flexion 


Muscle. 


Origin. 


Insertion. 


Sterno- 
mastoid 


See Extension 






Splenius 
capitis 


See Extension 






Com- 
plexus 


See Extension 






Obliquus 
superior 


From the transverse 
process of the atlas 


The occipital bone beneath complexus 




Rectus ca 
from 

the s 


pitis lateralis, a small m 
the transverse process of 
ide of the foramen magn 


uscle in series with the other recti 
the atlas to the occipital bone at 
um 


Rotation 


Sterno-m 


astoid 






Splenius 


capitis 






Complexu 


s 






Recti capi 


ti postici (major and mi 


nor) 


1 


' Obliqui 


(superior and inferior) 





SECTION YI 
THE DIGESTIVE SYSTEM 

THE digestive system includes the alimentary canal and various 
organs connected with it. The greater part of the digestive 
system lies within the abdomen. The alimentary canal consists 
of the following parts : Mouth, pharynx, oesophagus, stomach, 
duodenum, small intestine (jejunum, ileum), large intestine, 
rectum ; and the organs connected with it are salivary glands, 
liver, pancreas. The whole of the alimentary canal consists of 
structures formed of one or more muscular coats lined with 
mucous membrane. 

The Mouth is the first division of the alimentary canal, and 
contains the parts necessary for mastication and the openings 
of the ducts of the salivary glands. The food passes from the 
mouth into the pharynx, a large space at the back of the nose 
and mouth, containing in its lower half the greater part of the 
tongue and the larynx. The pharynx ends at the level of the 
sixth cervical vertebra, and from it pass the larynx and trachea 
in front and the oesophagus behind. 

The (Esophagus is the part of the digestive canal which leads 
from the pharynx to the stomach. It is a muscular tube, flat- 
tened by the trachea and the other structures lying on it. It lies 
in the thorax and extends from the sixth cervical vertebra to 
the eleventh dorsal vertebra, where it passes through the dia- 
phragm and enters the stomach. It is closely applied to the 
vertebral column, lying behind the other structures in the 
thorax. 

The Abdominal Cavity, which contains the rest of the 
alimentary canal, is bounded above by the diaphragm, below 
by the pelvic floor, posteriorly by the lumbar vertebras, and 

116 






PERITONEUM 117 

anteriorly and laterally by the abdominal muscles and iliac 
bones. The false pelvis is included in the abdominal cavity. 
The abdomen is divided up into nine regions by two horizontal 
lines and two vertical lines. 

The subcostal line, the upper of the two horizontal ones, is 
drawn round the trunk at the level of the lower border of the 
tenth costal cartilage. The intertubercular line the lower 
horizontal one is drawn at the level of the tubercles on the 
crests of the iliac bones, about two inches behind the anterior 
superior spine. This is the highest point of the iliac crests. 
The vertical or Poupart's lines are drawn from a point midway 
between the anterior superior spine of the ilium and the sym- 
physis of the pubis. 

By this means we have three regions in the middle line the 
epigastric, umbilical, and hypogastric, and laterally the hypo- 
chondrium, lumbar, and iliac regions. 

The Peritoneum is a serous sac which lines the abdominal 
cavity and invests all the structures. It is a thin membrane, 
secreting sufficient fluid to keep the whole surface lubricated 
and to enable the organs to move easily over one another. The 
peritoneum is really one sac, and its arrangement is very com- 
plicated, as it invests all the organs and connects them with the 
abdominal wall. 

The connections of the organs to the abdominal wall and to 
one another are called by three different names : 

Omenta folds of peritoneum connecting the stomach with 
any other organ. 

Mesenteries folds of peritoneum connecting the intestines 
with the abdominal wall. 

Ligaments folds of peritoneum connecting organs (not parts 
of the alimentary canal) to one another or to the abdominal 
wall. 

Following the peritoneum up the anterior abdominal wall, it 
passes over the under surface of the diaphragm ; from the pos- 
terior edge of that it is reflected back over the upper surface of 
the liver. It then turns round the anterior edge of the liver 
and, forming the anterior fold of the small omentum, meets the 
stomach ; it covers the anterior surface of the stomach and hangs 



118 



HANDBOOK OF ANATOMY 



down in a large fold called the great omentum. The posterior 
fold of the great omentum passes up over the posterior surface 
of the colon, where it is carried by the vessels to the posterior 
abdominal wall, and is carried off that, by the vessels, in a fan- 
shaped process the mesentery which invests the small intestine. 
After passing round the small intestine it again goes back to 
the posterior abdominal wall, where it passes down over the 



Parietal Peritoneum 



Outline of Diaphragm 



Gastro-hepatic Omentum ? 



Transverse Meso-colon 
Great Omentum 



The Mesentery 



Parietal Peritoneum 




FIG. 46. THE PERITONEUM. 



rectum and the upper part of the pelvic organs to the anterior 
abdominal wall. This constitutes the great sac of the peri- 
toneum. The small sac covers the posterior half of the under 
surface of the liver, forms the posterior fold of the small omen- 
tum, and covers the posterior surface of the stomach; it then 
forms a fold inside that of the great omentum, and passes up 
over the anterior surface of the colon, back to the posterior 
abdominal wall. 



STOMACH 



119 



The Stomach is a pyriform sac with two openings the oeso- 
phageal or cardiac, opening, and the pylorus, opening into the 
duodenum. The stomach has two ends, two surfaces, two 
curvatures, and two openings. 

The large cardiac end is directed backwards and to the left 
and the narrow pyloric end is directed to the right. The 
stomach lies in the left hypochondrium and left half of the 
epigastrium, under the left cupola of the diaphragm. In 
extreme extension it may reach down below the subcostal plane. 

Cardiac end 



(Esophagus 




Pyloric end 
Duodenum 



Great Curvature 



THE STOMACH. 



The length of the stomach is 10 to 11 inches and its greatest 
diameter 4 to 4| inches ; its capacity as a rule does not exceed 
40 ounces (1 quart). 

The stomach is composed of three layers of muscles with their 
fibres running in different directions, which insures thorough 
contractions of all parts taking place during digestion. When 
empty, the stomach in the healthy state is not collapsed, but 
contracted. 

The stomach lies in a cavity surrounded by other organs, 
and to this cavity is often given the name of the stomach 
chamber. 



120 HANDBOOK OF ANATOMY 

The Stomach Chamber. The roof is formed of the under 
surface of the left lobe of the liver and the left cupola of the 
diaphragm; this latter slopes down behind and forms the 
posterior wall. The anterior wall is formed by the abdominal 
wall between the ribs on the left and the liver on the right. 
The floor on which the stomach rests is formed by the top of the 
left kidney and suprarenal capsule, the gastric surface of 
the spleen, upper surface of the pancreas, and coils of small 
intestine. 

The Intestines are divided into three parts the duodenum; 
the small intestine, consisting of jejunum and ileum ; and the 
large intestine. The structure of the duodenum and small intes- 
tine is alike ; they consist of two muscular coats an inner circular 
layer and an outer longitudinal layer. The mucous membrane 
is covered by a number of villi, small processes about ^ inch 
long, and closely set all over the surface; they are for the 
purposes of absorption. In order to increase the surface, the 
mucous membrane is arranged in a series of circular folds 
called valvulce conniventes. On the surface of the mucous 
membrane are found also Peyer's patches, which are small aggre- 
' gations of lymphoid tissue about J inch long ; there are about 
thirty-five to forty of them usually found, most marked in young 
subjects. 

The Duodenum is really the first part of the small intestine, and 
starts at the pyloric orifice of the stomach, on the left side of 
the body of the first lumbar vertebra. It is a C-shaped organ,, 
closely applied to the back wall of the abdomen. It starts at 
the level of the first lumbar vertebra, passes downwards and to 
the right as low down as the third lumbar vertebra and, turning 
upwards, ends on the left side of the body of the second lumbar 
vertebra at the duodeno-jejunal flexure, being the point at 
which the jejunum, or second part of the small intestine,, 
begins. 

In the curve of the duodenum lies the head of the pancreas, 
the body passing to the left between the two ends. The 
duodenum lies on the vena cava and aorta and the two psoas 
muscles. It touches the right kidney, and is covered by coils of 
small intestine. 



INTESTINES 121 

On the inner surface of the duodenum just behind the pylorus 
is seen a small prominence the bile papilla on which is the 
common opening of the bile and pancreatic ducts. 

The Jejunum is the second part of the small intestine, and the 
Ileum is the third part. They measure about 20 feet together, 
and start at the duodeno-jejunal flexure, ending by the junc- 
tion of the ileum with the large intestine at the colic valve. 

The coils of the small intestine lie in the abdominal cavity, 
varying considerably in their disposition, as they are in continual 
movement. 

There is very little difference between the jejunum and ileum, 
and the transition of one to the other is gradual. The ileum is 
smaller in diameter, has fewer valvulae conniventes and a larger 
number of Peyer's patches than the jejunum. 

The Large Intestine consists of several parts the csecurn, 
ascending, transverse, and descending colons, sigmoid flexure of 
colon, and rectum. 

The structure is similar to that of the small intestine except 
that it has no villi and the longitudinal coat of muscle consists 
of three longitudinal bands, so that the organ has a sacculated 
appearance. 

Small processes of peritoneum distended with fat called 
appendices epiploictf hang from the outer wall of the large 
intestine. 

The Caecum is a small sac about 2-J inches long and 3 inches 
wide which forms the blind end of the large intestine and lies- 
below the colic valve, or entrance of the ileum into the large 
intestine ; it lies in the right iliac fossa in front of the psoas 
muscle. Just below the colic valve, the appendix opens out 
from the caecum. It is a small blind process, very often with no 
lumen at all, about 3J inches long; it lies behind the caecum,, 
generally pointing upwards and to the left, but the position is 
very variable. 

The Ascending* Colon (length about 8 inches) is the continua- 
tion upwards of the caecum. It lies in the groove between the 
right psoas and quadratus lumboruni, and the front of the right 
kidney. When it reaches the liver it forms the hepatic flexure 
by bending at an angle to the left and is continued as 



122 HANDBOOK OF ANATOMY 

The Transverse Colon (length about 20 inches) which forms 
a loop across the abdomen. It passes in front of the duodenum 
and pancreas and behind the stomach ; it then passes upwards 
and backwards until it reaches the base of the spleen, where it 
forms the splenic flexure by turning sharply downwards and 
becoming 

The Descending 1 Colon (length about 6 inches). It lies on 
the front of the left kidney, then in the groove between psoas 
and quadratus lumborum. It is covered by coils of small 
intestine. 

' The Sigrnoid Flexure, or iliac and pelvic colons, are the con- 
tinuation of the descending colon. The latter ends at the iliac 
crest and is continued as the iliac colon, which crosses the left 
iliac fossa; then entering the true pelvis crosses over to the 
right and back to the middle line, where it is continued as the 
rectum, beginning at the level of the third sacral vertebra. 

The Rectum is the dilated end of the large intestine, ending in 
the anal canal, at a point just below the level of the tip of the 
coccyx and 1J inches in front of it. It is an S- shaped organ 
about 6 inches long, and closely follows the curve of the sacrum. 
The anal canal is about 1 inch long, and is a slit-like passage 
passing between the two levator ani muscles, which, joining in 
the middle line, form the floor of the* pelvis. 

The Digestive Glands consist of the salivary glands, of which 
there are three pairs ; the liver; and the pancreas. 

The Parotid Gland, the largest of the three, lies in a hollow 
just in front of the ear. Above, it reaches up to the zygoma 
and is intimately associated with the temporo-mandibular 
joint. Anteriorly, a process of the gland passes forwards over 
the masseter muscle. It extends as far down as the angle 
of the jaw and slightly backwards over the sterno-mastoid 
muscle. 

The duct (Stenson's) leaves the gland at the anterior border, 
passes forwards over the masseter, and pierces the buccinator to 
reach the inside of the mouth. 

The facial nerve passes through the parotid gland and in its 
substance breaks up into branches. 

The Submaxillary Gland is the next largest ; it lies in a recess 



SALIVARY GLANDS 



123 



iust inside the angle of the mandible. It lies on the mylohyoid 
muscle and posteriorly is in contact with the sterno-masi 

muscle. , -, 

The duct (Wharton's) leaves the deep surface ot 

and passing forwards beneath the mylohyoid muscle pier< 

floor of the mouth under the tongue. 
The Subling-ual Gland is a small gland which 

floor of the mouth under the tongue, covered only by mucc 

membrane. 



Stenscm s Duct 




Rivini 



\; 

Wharton's Duct 



FIG. 48. THE SALIVARY GLANDS. 

The ducts (of Rivini) are numerous and small, and pierce the 
mucous membrane covering the gland. 

The Liver is the largest of all the digestive glands. It lies 
beneath the right cupola of the diaphragm and against the ribs 
on the right side of the body. Its function is to secrete the bile, 
which is carried to the duodenum by the bile-duct. On the bile- 
duct is a small diverticulum the gall bladder in which the 
bile is stored until required. 

The liver lies mainly in the right hypochondrium, but the 
thin left side of it reaches as far as the left Poupart plane. Its 
lower border extends from the sixth costal cartilage on the left 
side to the tenth rib on the right side ; it very often extends 



124 



HANDBOOK OF ANATOMY 



downwards a little lower on the right side. The upper limit, 
anteriorly, corresponds with the line of the diaphragm i.e., the 
fifth intercostal space on the right, and the sixth costal cartilage 
on the left, with a depression in the middle. The mass of the 
liver is divided into right and left lobes by the falciform liga- 
ment, a fold of peritoneum connecting the liver with the anterior 
abdominal wall and diaphragm. 

The liver has two surfaces visceral and parietal. The 
Parietal surface lies above, against the diaphragm anteriorly, 



Inferior Vena Cava 



Lobus Spigelii 
Venosal Fissure 
CEsophageal Groove 



Vena Portae 




Lobus Caudatus 

Impressio Suprarenalis 

Uncovered Area of Right Lobe 

Impressio Duodenalis 



Impressio Renali& 



c * sticDuct 



Impressio Gastric 
on Left Lobe 



Tuber Omentale 

Hepatic Artery 

Hepatic Duct ' , ! Gall-bladder 

J Lobus Quadratus 
Round Ligament Ductus Communis Choledochus 

FIG. 49. THE LIVER. 

against the abdominal wall, laterally, against the ribs, from 
which it is separated by the diaphragm, posteriorly, also against 
the diaphragm. The whole of the liver is covered by peritoneum 
except a small portion of the posterior surface known as the 
"uncovered area/' which is in direct relation with the dia- 
phragm. 

The " uncovered area " is a small portion of the liver which 
lies between the two coronary ligaments, the folds of peritoneum 
passing from the liver to the abdominal wall. On the "uu- 



PANCREAS 125 

covered area" is a small triangular impression made by the 
right suprarenal capsule, and to the left of this a deep groove 
into which fits the vena cava. To the left of the vena cava lies 
the Spigelian lobe, a small prominent portion of liver substance. 
To the left -of the Spigelian lobe lies the groove for the osso- 
phagus. 

The Visceral surface is a sloping surface looking obliquely 
downwards, backwards, and to the left. It lies upon the 
stomach, intestines, and right kidney. 

The visceral surface of the left lobe lies on the cardiac portion 
of the stomach and the lesser curvature where the small omentum 
is attached. The stomach makes a deep concave impression on 
the liver, and above, the liver substance bulges out, forming the 
omental tuberosity. The visceral surface of the right lobe is 
divided into two portions by the gall-bladder, the portion on the 
left being called the quadrate lobe. Between the left lobe and 
the quadrate lobe is the portal fissure, to which the small omen- 
tum is attached. In the portal fissure lie the portal vein, 
hepatic veins, and hepatic artery. On the right of the gall 
bladder are three impressions that of the duodenum just above, 
and to the right that of the right kidney, and below, the hepatic 
flexure of the colon (see Fig. 49). 

The Hepatic Duct is formed by the union of the ducts from 
the right and left lobes, and joined by the cystic duct from the 
common bile-duct, which lies in the portal fissure. 

The Gail-Bladder is a diverticulum of the bile-duct to form a 
reservoir for the bile. It is a pear-shaped bag, the wide end of 
which usually protrudes below the inferior border of the liver 
and touches the abdominal wall at the level of the ninth costal 
cartilage on the right side. 

The Pancreas is a long, narrow gland lying transversely on 
the posterior abdominal wall. It has no true capsule, so 
the lobulations are apparent. In shape the pancreas can be 
compared to a J turned on its side thus c.. It is divisible 
into a head, body, and tail. The head lies in the curve of the 
duodenum, the body on the posterior abdominal wall crossing 
in front of the left kidney, and the tail comes in contact with the 
spleen. Behind the head of the pancreas are the vena cava and 



126 HANDBOOK OF ANATOMY 

aorta. The upper surface of the body is wide (in transverse 
section the body is triangular), and forms part of the floor of the 
stomach chamber, and the anterior surface is in relation with 
the coils of the small intestine. 

The whole of the pancreas is covered by peritoneum, except 
the posterior surface, which is closely applied to the abdominal 
wall and kidney. 

The Pancreatic Duct commences at the tail of the organ. It 
emerges at the head, and, meeting the bile-duct, the two pierce 
the wall of the duodenum and open by a common orifice. 



SECTION VII 
THE DUCTLESS GLANDS, KIDNEYS AND PELVIC ORGANS 

THE Ductless Glands are a number of organs in different 
parts of the body, which, as their name implies, have no ducts, 
but pour their "internal secretion" direct into the vascular 
system. The principal ones are the lymphatic glands, the thy- 
roid gland, suprarenal capsules, and spleen. 

The Thyroid Gland is a very vascular structure situated at the 
upper end of the trachea, and extending upwards on the sides of 
the larynx. It consists of three parts, two lateral lobes joined 
in the middle line by the body. It is always relatively larger in 
the female and child than in the male. 

The lateral lobe is triangular in shape, the base extends as 
far down as the fifth or sixth ring of the trachea, and the apex 
reaches up to the side of the thyroid cartilage. It is covered 
by some of the infrahyoid muscles and the sterno-mastoid 
muscle, and posteriorly it touches the oesophagus and common 
carotid artery. 

The body is a narrow band uniting the lower ends of the 
lateral lobes and lying on the second and third rings of the 
trachea. 

The Spleen is one of the abdominal organs, but not connected 
with digestion. It is the largest of the ductless glands. 

It lies in the left hypochondrium in the mid-axillary line reach- 
ing from the upper border of the ninth rib to the upper border 
of the twelfth, its long axis being in the same direction as that 
of the tenth rib. It has an irregular shape. The outer surface 
is convex and more or less oval, and closely applied to the dia- 
phragm which separates it from the ribs. The visceral surface 
is divided into three parts by ridges, which join to form a more 

127 



128 



HANDBOOK OF ANATOMY 



or less prominent apex in the centre. The upper and largest 
part has a deep concave impression formed by the stomach ; the 
two lower parts are in contact respectively with the left kidney 
and the splenic flexure of the colon. At the lower border of 
the gastric impression is the hilus, where the bloodvessels and 
nerves enter, and just below this is the impression made by the 
tail of the pancreas. 

The spleen is almost completely covered by peritoneum, and two 
folds pass from it connecting it with the stomach and kidney, 
called, respectively, the gastro-splenic and lieno-renal ligaments. 



Hiium : 




. Anterior Basal Angle 
- Pancreatic Impression 
Internal Basal Angle 



FIG. 50. THE SPLEEN. 

The Suprarenal Capsules are two small triangular bodies 
Testing on the upper ends of the kidneys. 

The right suprarenal capsule is in contact anteriorly with the 
vena cava and the liver ; posteriorly it is in contact with the 
diaphragm, and its inferior surface rests on the anterior in- 
ternal aspect of the upper end of the kidney. The peritoneum 
covers a very small portion of the anterior surface. 

The left suprarenal capsule has a rounded apex, so is more 
semilunar than triangular. It is also placed lower down on 
the inner border of the left kidney instead of on the upper end. 
The greater part of the anterior surface is in contact with the 
stomach, and is covered with peritoneum ; the lower remaining 
part is behind the pancreas. Posteriorly the left suprarenal 



KIDNEYS 129 

-capsule is in contact with the left cms of the diaphragm and 
the inner border of the kidney. 

The Kidneys are a pair of organs placed on the posterior 
wall of the abdomen, which secrete the urine : the urine is 
carried by means of the ureter to the bladder, situated in the 
pelvis, which opens to the exterior by means of the urethra. 

They are bean-shaped organs lying on the posterior wall 
of the abdomen, with their long axes vertical and the hilus 
placed towards the middle line. The position of the kidneys 
varies somewhat with the individual, but as a rule the right 
kidney is at a lower level than the left. The greater part of 
the kidneys lies to the inner side of a line drawn vertically up- 
wards from the mid-point of Poupart's ligament (this is not the 
same as the mid-Poupart plane). The posterior surface of the 
kidney is closely applied .to the diaphragm, psoas, and quad- 
ratus luinborum muscles, and tendon of transversalis in front 
of the twelfth rib and transverse processes of the first three 
lumbar vertebrae. The lower end is usually from 1J to 2 
inches above the crest of the ilium, and is farther from the 
middle line than the upper. The kidneys lie entirely behind 
the peritoneum, and are held in position by a quantity of fat. 
The kidney is slightly rotated in position so that the hilus pro- 
jects forward. 

On the upper end of each kidney is a ductless gland, the 
suprarenal capsule (described above). 

The relations of the anterior surface differ on the two 
kidneys. The right kidney has on its anterior surface, above 
and internally, the suprarenal capsule. Below that a large 
part of the surface is in contact with the visceral portion of 
the liver, and below that the kidney is in contact with the 
duodenum and the beginning of the transverse colon. 

On the anterior surface of the left kidney, above and inter- 
nally, is the impression of the suprarenal capsule ; just below is 
a small surface in contact with the stomach, and below again 
the pancreatic surface. To the right of these there is the gastric 
surface, and the lower end is in contact with the jejunum in- 
ternally and the transverse colon externally. 

At the hilus below the renal artery is the pelvis of the> 

9 



130 HANDBOOK OF ANATOMY 

kidney a thin-walled funnel-shaped sac formed by the junc- 
tion of several calyces inside the kidney; the pelvis rapidly 
narrows to form the ureter. 

The Ureter is a duct with a small lumen and thick muscular 
walls. It is about 9 inches in length. The upper half or rather 
more lies in the abdominal cavity, the rest in the pelvis. The 
ureter passes downwards and inwards lying on psoas, and, 
crossing the iliac artery, it enters the pelvis. It then passes, 
down on the side wall of the pelvis under the peritoneum,, 
curving backwards close to the great sciatic notch. At the level 
of the ischial spine it bends inwards and enters the bladder 
about an inch from the middle line. 

The Pelvic Organs. The pelvis contains the bladder, the 
rectum, and the internal genital organs. The bladder lies an- 
teriorly close against the pubic bones, the rectum posteriorly 
close against the sacrum (see Section VI.), and the internal 
genital organs between the two. They are all covered 
superiorly by peritoneum. 

The bladder is a hollow organ with muscular walls capable of 
great distension. When empty and contracted, it lies entirely in 
the pelvis just behind the symphysis pubis ; when distended, it 
rises above the pelvis into the abdominal cavity. Superiorly it 
is covered by peritoneum reflected from the anterior abdominal 
wall and the sides of the pelvis, and is in relation with the coils; 
of the small intestine. The under surface lies on the symphysis 
pubis and the bodies of the pubic bones; externally it is in contact 
with the levator ani and obturator internus muscles on each 
side. Posteriorly it is separated from the rectum by the uterus 
and vagina in the female, and the seminal vesicles in the male. 
The lower part of the bladder only moves in position very 
slightly; during distension the side and upper walls expand 
and rise into the abdominal cavity. In the posterior wall of 
the bladder are the openings of the two ureters and the urethra. 
The three openings form an equilateral triangle with the apex 
downwards and the sides are about I inch long. 



SECTION VIII 
THE RESPIRATORY ORGANS 

THE Organs of Respiration are the lungs and trachea, the 
latter being the passage by means of which air is carried from 
the pharynx to the lungs. 

Breathing consists of the acts of inspiration and expiration; 
in the former, air is drawn into the pharynx through either the 
nose or mouth and conveyed by means of the trachea to the 
lungs ; the air is expelled in the same way. 

The upper part of the air passage, the larynx, is specially 
modified by cartilages and muscles to produce sounds i.e., the 
voice during expiration. 

The Pharynx is a large space behind the nose and mouth in 
the lower part of which are the openings of the larynx and 
oesophagus ; the pharynx is compressed laterally, and its anterior 
wall is practically non-existent, the lateral walls being attached 
to the sides of the nasal, buccal and laryngeal orifices. The 
posterior wall is attached by areolar tissue to the muscles in 
front of the first six cervical vertebrae, and above, it is attached 
to the basilar process of the occipital bone and to the temporal 
bones. 

The upper part of the pharynx is almost separated off from 
the lower part by the soft palate, which projects backwards from 
the palatal processes of the maxillary bones, and in this upper 
part is found the orifices of the Bustachian tube and the pharyn- 
geal tonsil. Below the soft palate is the tonsil on each side. 
Below this the pharynx rapidly narrows as it passss the opening 
of the larynx and becomes the oesophagus. 

The Larynx is the upper part of the air passage, and is placed 
in front of the fourth, fifth, and sixth cervical vertebrae. It con- 

131 



132 



HANDBOOK OF ANATOMY 



sists of several cartilages held together by muscles. The largest 
the thyroid cartilage consists of two large plates of cartilage 
joined at an angle in the middle line ; in the male this angle is 
about 90 degrees, and projects forward, forming what is called 
the "Adam's apple." Below the thyroid cartilage is the cricoid 
cartilage, in shape like a signet ring with the narrow part in 
front. The interval between the two can easily be felt in the 



Frontal Air-Sinus 



Superior Meatus 



Superior Concha 

' Spheno-ethmoidal Recess 



Inferior Meatus 
Hard Palate (in section) ^TlCI 
Tongue 



Mandible (in section) ._ 



Genio-hyo-glossus 

Genio-hyoid 




. Sphenoidal Air-Sinus 
__ Middle Concha 

Middle Meatus 

Inferior Concha 
.Eustachian Orifice 
Salpingo-pharyngeal 

....Soft Palate 



Epiglottis 

.... Pharynx 



Ventricle of Larynx 
Thyroid Cartilage 
Cricoid Cartilage 

Trachea 

FIG. 51. THE PHAKYKX. 



(Esophagus 



living subject. The thyroid cartilage is joined by a strong 
membrane to the hyoid bone, and from its inner side the 
epiglottis, a cartilaginous process, projects upwards to the back 
of the tongue. 

The Trachea is the continuation of the air passage ; it begins 
just below the cricoid cartilage at the level of the sixth cervical 
vertebra and ends at the fourth thoracic vertebra by dividing into 
two bronchi. The trachea is a muscular tube kept permanently 



LARYNX 



133 



patent by rings of cartilage, which, however, are not complete 
posteriorly, so the organ is not quite cylindrical. These cartila- 
ginous rings are continued in the bronchi. 

The trachea follows the curve of the vertebral column, so 
passes obliquely backwards as it descends. It is in the middle 
line until the bifurcation is reached, where it lies slightly to the 
right. 

The Bronchi pass obliquely downwards aud outwards from 
the bifurcation of the trachea to the roots of the lungs. The 



Superior Cornu of Thyroid 
Cartilage 



Isthmus (Pomum Adami) 




^~*Crico-thyroid Ligament 



Cricoid Cartilag= 

FIG-. 52. THE LARYNGEAL CARTILAGES. 

right bronchus is shorter and wider than the left, and is not so 
obliquely placed. The bronchi have several branches passing to 
the different lobes of the lungs. 

The Lung's lie within the pleural cavities of the thorax. A 
perfectly healthy lung lies quite free within its own pleural sac, 
attached only by its root ; but as a rule adhesions between the 
lung and pleura are found. The right lung is larger than the 
left, the proportion being about eleven to ten . It is also shorter 
and wider. 

The lungs take the shape of the pleural cavities, and are 
conical structures having an apex which projects above the level 
of the first rib for about half an inch, and a concave base 
which is adapted to the cupola of the diaphragm, on which it 
rests. The outer surface is smooth and convex, except for shal- 
low grooves made by the ribs, and the inner surface has the 



134 HANDBOOK OF ANATOMY 

impressions of the organs against which it lies. The lower 
border of the outer surface of the lung is thin and reaches 
down between the diaphragm and the ribs to the level of the 
lower border of the sixth rib in front; the eighth rib in the mid- 
axillary line; then passes horizontally inwards, reaching the 
vertebral column at the level of the tenth rib. The bases of the 
lungs are in relation with some of the abdominal organs, the 
diaphragm intervening. Thus, the base of the right lung rests 
upon the right lobe of the liver, whilst the base of the left lung 
is in relation with the left lobe of the liver, the fundus of the 
stomach, and the spleen. 

On the anterior and lower part of the inner surface of each 
lung is a deep recess made by the pericardium (this is deeper in 
the left than the right) , and above the pericardial concavity is 
the hilum of the luiig, where the bronchial vessels and nerves 
enter, constituting the root of the lung. On the left lung, above 
and behind the hilum is a broad shallow groove made by the 
descending thoracic aorta. 

The left lung is divided into two lobes by a groove reaching 
into the hilum ; it starts above on the outer surface just below 
the apex and passes obliquely forwards and downwards to the 
base near the middle line. The right lobe is divided by a 
similar line into two, which, however, cuts the base nearer the 
outer side. The inner and upper lobe is then subdivided by a 
horizontal line passing inwards and forwards from about the 
middle of the first line. 

The lungs entirely fill the thoracic cavity except for the space 
in the middle occupied by the trachea, oesophagus, large vessels, 
heart, and roots of the lungs. 

The Roots of the Lung's are formed by a number of structures 
which pass into each lung at the hilum ; they consist of the pul- 
monary veins, the pulmonary artery and the bronchus, nerves, 
lymphatic vessels and glands. 

The Pleura is a serous membrane which invests the lungs and 
lines the thoracic cavity. It is analogous to the peritoneum of 
the abdomen, and performs the same function i.e., forms a 
lubricated covering, so that the organs can move freely in the 
cavity. The part lining the cavity is called the parietal pleura, 



LUNGS . 135 

and the part covering the lungs the visceral pleura. The 
latter is very thin and adherent to the lung, and dips into all the 
fissures. 

The parietal pleura is named according to the part over which 
it passes. The cervical pleura rises up to the level of the neck 
of the first rib. Owing to the oblique position of the latter, the 
pleura is about an inch and a half above the level of the clavicle ; 
it is strengthened by Sibson's fascia, a strong membrane 
attached to the seventh cervical vertebra and the inner margin 
of the first rib. The costal pleura lines the inner surfaces of 



STERNUM 




FIG. 53. THE PLEURA. 

the ribs and the intercostal spaces ; it reaches to the sternum 
in front and the bodies of the vertebrae behind. The 
diaphragmatic pleura covers the surface of the diaphragm 
except for the middle part, occupied by the pericardium, and a 
narrow strip at the costal attachment. The mediastinal pleura 
passes back from the sternum to the vertebral column and lines 
the space (mediastinum) between the lungs. As it passes back 
it is reflected by the root on to the lung, and becomes the visceral 
pleura (see Fig. 53). Below the root of the lung the two layers 
hang down in a deep fold called the ligamentum latum pulmonis. 
The parietal pleura is bigger than the lungs require at rest, 



136 HANDBOOK OF ANATOMY 

and is not quite so big as the entire cavity, the line of reflection 
being 

Right pleura : Anterior, down the middle line of the sternum 
to the back of the ensiform cartilage, along the seventh costal 
cartilage, and across the bony extremities of the eighth and 
ninth ribs. In the mid-axillary line the pleura reaches its- 
lowest limit that of the bony tip of the tenth rib. It then 
ascends slightly, cutting across the eleventh rib to the middle of 
the twelfth rib and on to the first lumbar vertebra. The 
posterior line of reflection is to the left of the mid-line of the 
vertebral bodies, the aorta intervening between them. 

Left pleura : This only differs from the right in the anterior 
line of reflection. Opposite the fourth costal cartilage the left 
pleura deviates to the left, leaving a small area of pericardium 
uncovered. It cuts 'across the fifth, sixth, and seventh costal 
cartilages to the bony tip of the eighth rib, after which the line 
of reflection resembles that of the right pleura. 



SECTION IX 



HEART AND BLOODVESSELS OF HEAD, NECK AND TRUNK 

The Heart. 

THE Heart is a four-chambered muscular organ situated in 
the thorax, in the space between the lungs, and resting on the 
diaphragm. Its function is to receive the blood from the veins 
and to propel it through the arteries. 

The shape of the heart is that of a cone ; it has an apex, a 
base, and two surfaces (inferior and antero-superior) . A shallow 
groove runs round the heart transverse to its long axis, sepa- 
rating the upper auricular portion from the lower ventricular 
portion. The division of the upper portion into two auricles is 
only faintly marked, but a distinct groove divides the lower 
portion into two ventricles. 

The heart is enclosed in a fibro-serous sac the pericardium 
which separates it from the surrounding organs. It rests on 
the diaphragm, the long axis pointing obliquely downwards,, 
forwards, and to the left. On the surface of the body its position 
is marked by a quadrilateral area, the boundaries of which are 
as follows : 

Eight side a line slightly convex outwards from the upper 
end of the third costal cartilage to the sixth, its greatest 
distance from the middle line being 1| inches. 

Base from the lowest point on the right side to the fifth in- 
tercostal space on the left side, 3J inches from the middle line. 
This point marks the position of the apex of the heart. 

Left side a line slightly convex outwards from the left ex- 
tremity of the base line to the lower border of the second inter- 
space on the left side, 1 inch from the mid-line. 

137 



138 HANDBOOK OF ANATOMY 

Upper line a line slightly convex downwards connecting the 
upper extremities of the right and left sides. 

The Base of the Heart is formed by the auricles, and is 
directed upwards, backwards, and to the right. It lies opposite 
the sixth, seventh, and eighth dorsal vertebrae, separated from 
them by the oesophagus and descending aorta. It has six 
orifices the superior and inferior venae cavas entering the 

Superior Vena Cava t*^f*9f^S 

^.Aorta 



Right Auricular Appendix 



Right Auricle ^ 



, Pulmonary Artery 
,Conus Arteriosus 



Right Coronary Artery 




. Left Ventricle 

- Left Coronary Artery 



Apex 

FIG. 54. THE HEART. 

right auricle, and the four pulmonary veins entering the left 
auricle. 

The Apex of the Heart is formed entirely by the left ven- 
tricle. It is directed downwards, forwards, and to the left, and 
is separated from the anterior thoracic wall by the left lung 
and pleura. 

The Inferior Surface is formed by the ventricular portion of 
the heart, and rests upon the central tendon of the diaphragm 
and the muscular part to the left of the tendon. 

The Antero- Superior Surface is directed backwards, upwards, 
-and to the left. It lies behind the area of the anterior thoracic 



HEART 139 

wall mapped out above, and is divided into an upper and lower 
part by the auriculo- ventricular groove. At this point are the 
orifices of the pulmonary artery and aorta from the right and 
left ventricles respectively. 

The Interior of the Heart. Internally the heart is com- 
pletely divided into right and left halves by. a septum indicated 
on the outside by the longitudinal grooves. The transverse 
septum is not complete, as each auricle communicates with the 
ventricle below by a valvular opening. 

The Auricles are almost cubicle in form and each possesses a 
well-marked process from its upper angle, which projects for- 
wards on the outside of the heart, known as the auricular ap- 
pendix. The walls are lined with a serous membrane the 
endocardium and are smooth except in the region of the 
appendix, where there are a few muscular fibres, known as 
the musculi pectinati. The right auricle receives posteriorly the 
.superior vena cava above and the inferior vena cava below, the 
orifice of the latter being guarded by the rudimentary Eus- 
tachian valve. The left auricle resembles the right' auricle, 
except that it has four openings in its posterior wall the 
orifices of the pulmonary veins. 

The Ventricles are conical in form and very muscular, the 
left ventricle being larger and thicker-walled than the right. 
The longitudinal septum is so placed that the apex of the heart 
is formed entirely by the left ventricle. The right ventricle is 
continuous with the right auricle, its base giving origin to the 
pulmonary artery. The right auriculo- ventricular orifice is 
guarded by the tricuspid valve, and the orifice of the pulmonary 
artery is also guarded by a valve composed of three cusps. The 
left ventricle is continuous with the left auricle, its base giving 
origin to the aorta. The left auriculo-ventricular orifice is 
guarded by the mitral or bicuspid valve, and the orifice of the 
aorta by the aortic valve composed of three cusps. 

The cavities of the ventricles are lined with endocardium, 
and are smooth except for the muscle fibres, which are more 
numerous and more pronounced than those of the auricles. 
Each cavity can be divided into two the body of the ventricle 
and the vestibule of the vessel to which it gives origin. 



140 HANDBOOK OF ANATOMY 

The muscles are of three kinds : 

Columns Carneas bundles of muscle-fibre raised in relief on> 
the walls of the ventricle. 

Papillary Muscles which are attached at each end to the- 
walls of the ventricles, but are free in the middle. These pre- 
vent over-distension. 

Chordae Tendinese thin bundles of muscle-fibre from the 
bases of the papillary muscles to the apices of the cusps of 
the valves. 

The Valves of the Heart and large vessels are circular 
orifices with semilunar flaps of muscle (cusps) projecting inwards 
from the circumference. These meet in the middle and com- 
pletely close the orifice. A rush of blood pushes these forward, 
and the cusps automatically close the orifice when the flow 
ceases. This keeps the blood flowing in one direction and 
prevents regurgitation. 

The Pericardium is a fibro-serous sac surrounding the heart. 
It is attached to the diaphragm all round the inferior surface 
of the heart, and is prolonged upwards, being gradually lost 
on the great vessels. The inferior vena cava pierces the peri- 
cardium posteriorly. 

The Arteries. 

The arteries are the bloodvessels which leave the heart and 
break up into capillaries for the supply of the tissues. There 
are two systems of circulation the pulmonary, consisting 
of the pulmonary artery leaving the right ventricle and 
ending in the pulmonary veins which enter the left auricle;, 
and the systemic, consisting of the aorta leaving the left ven- 
tricle and ending in the superior and inferior venae cavae which 
enter the right auricle. 

The Pulmonary artery arises from the base of the right 
ventricle of the heart. It is a short vessel about 2 inches long. 
It passes upwards to the left of the ascending aorta, and termi- 
nates by dividing into right and left pulmonary arteries, which 
enter the roots of the right and left lungs respectively. 

The Aorta rises from the base of the left ventricle of 
the heart. It passes upwards, backwards, and to the left,. 



AORTA 



141 



forming an arch, which, on reaching the vertebral column, 
passes downwards as far as the body of the fourth lumbar 
vertebra, where it terminates by dividing into the two common 

Trachea 



.. Left Common Carotid Artery 
Scalenus Anticus Muscle 



.. Left Pneumogastric Nerve 

Left Subclavian Artery 

(Third Part) 
Left Phrenic Nerve 

..Left Superior Intercostal 
Artery 

__ Cervical Cardiac Branches 
of Left Symp. and Vagus 
_. Superficial Cardiac 
Plexus 



_.. Left Bronchus 




FIG. 55. THE AORTA. 



iliac arteries. For convenience of description it is divided 
into four parts : (1) The ascending aorta, (2) the arch of the 
aorta, (3) the descending thoracic aorta, (4) the abdominal 
aorta. 



142 HANDBOOK OF ANATOMY 

The Ascending Aorta arises from the base of the left ven- 
tricle opposite the lower border of the third left costal cartilage. 
It passes upwards, forwards, and to the right, terminating in 
the arch of the aorta at the level of the junction of the right 
second costal cartilage with the sternum. 

Branches. Right and left coronary arteries, which supply the 
heart muscle. 

The Arch of the Aorta lies behind the lower part of the nianu- 
brium, and begins at the termination of the ascending aorta, 
terminating as the descending aorta opposite the lower border 
of the body of the fourth dorsal vertebra. The arch passes 
upwards, backwards, arid to the left in front of the trachea, and 
curving over the pulmonary artery ; it then passes backwards to 
the left of the trachea and turns downwards. 

Branches of the Arch of the Aorta supply the head and neck 
and upper limb. The branch on the right side the innominate 
artery is a very short trunk, which divides almost at once into 
right common carotid and right subclavian arteries; the left 
common carotid and left subclavian arteries are given off from 
the arch itself. 

The Descending Aorta extends from the termination of the 
arch at the fourth dorsal vertebra, and ends at the opening in 
the diaphragm opposite the twelfth dorsal vertebra, by becoming 
the abdominal aorta. It lies on the vertebral column and is in 
contact anteriorly with the root of the left lung, the pericardium,, 
the oesophagus, and the crura of the diaphragm. 

The branches are divided into two sets, visceral and parietal, 
supplying the muscles of the thorax and its contents. 

The Abdominal Aorta extends from the middle of the body 
of the last dorsal vertebra to the left side of the body of the 
fourth lumbar vertebra, where it divides into the two common 
iliac arteries. The bifurcation^ in the intertubercular plane. 
It lies on the vertebral column, and anteriorly is in contact with 
the solar plexus, the third part of the duodenum, the mesentery, 
peritoneum, and coils of small intestine. The pancreas is 
separated from the aorta by the splenic vein and superior 
mesenteric artery. 

Branches. The branches are divided into two sets visceral 



AORTA 143 

and parietal and each set is again divided into paired and un- 
paired groups, which supply the viscera, the muscles of the 
trunk and the lower limbs. 

The lumbar arteries which supply the muscles of the trunk 
arise down the sides of the aorta opposite the bodies of the 
lumbar vertebras. 

The Common Carotid arteries vary slightly at their com- 
mencement ; otherwise they are similar in course and dis- 
tribution. 

The Bight Common Carotid artery arises from the innomi- 
nate artery behind the right sterno-clavicular articulation; the 
left arises direct from the arch of the aorta about an inch below 
the left sterno-clavicular articulation. They both terminate at the 
level of the upper border of the thyroid cartilage of the larynx,, 
or the lower border of the third cervical vertebra. They are 
separated from one another below by the trachea and oeso- 
phagus, above by the pharynx. 

The common carotid artery is enclosed in a fibrous sheath 
with the vagus nerve and internal jugular vein. It lies on 
scalenus anticus and longus colli muscles below, and rectus 
capitis anticus major above, and is covered by sterno-mastoid. 
On its outer side lies the internal jugular vein, which slightly 
overlaps it below. 

Branches. The artery bifurcates at its termination, forming 
the external and internal carotid arteries. 

The External Carotid artery extends from the bifurcation of 
the common carotid artery to the back of the neck of the man- 
dible, where it terminates by dividing into the superficial tem- 
poral and internal maxillary arteries. 

Branches. Occipital. 

Superficial temporal. 

Internal maxillary, and five other branches which 
supply the face, tongue, pharynx, and larynx. 

The Occipital artery runs upwards under the mastoid process 
to the back of the scalp, and terminates near the inner end of 
the superior curved line of the occipital bone. By dividing into- 
branches it supplies the scalp and surrounding structures. 

The Superficial Temporal artery commences in the parotid 



144 



HANDBOOK OF ANATOMY 




FIG. 56. THE AORTA IN THE THORAX, AND THE PRINCIPAL ARTERIES OF 
THE HEAD AND NECK. 



1. Arch of the Aorta 

2. Aortic Isthmus 

3. Aortic Spindle 

4. Descending Aorta 

5. Coronary Arteries (from 

Ascending Aorta) 

6. Innominate Artery 

7. Left Common Carotid 

8. Left Subclavian 

9. Right Common Carotid 



10. Right Suhclavian 
n. External Carotid 

12. Internal Carotid 

13. Internal Maxillary 

14. Superficial Temporal 

15. Vertebral 

16. Internal Mammary 

17. Thyroid Axis 

1 8. Inferior Thyroid 

19. Transverse Cervical 



20. Suprascapular 

21. Superior Thyroid 

22. Lingual 

23. Facial 

24. Occipital 

25. Posterior Auricular 

26. Ascending Pharyngeal 

27. Transverse Facial 

28. Aortic Intercostals 



gland and runs straight up, terminating about 2 inches above 
the zygoma by dividing into branches. It supplies the scalp 
and surrounding structures. 



CAROTID ARTERIES 145 

The Internal Maxillary artery commences in the parotid gland 
and passes inwards to supply the teeth and structures behind 
the superior maxilla and mandible. 

The Internal Carotid artery commences at the bifurcation of 
the common carotid and terminates in the brain by dividing into 
branches. At first it lies on the outer side of the external 
carotid, but passes behind it and gets to the inner side. It 
passes up at the back of the parotid gland and reaches the brain 
by means of the carotid canal in the temporal bone. 

The Subclavian arteries also vary slightly at their com- 
mencement, the right subclavian artery commencing at the 
bifurcation of the innominate artery behind the right sterno" 
clavicular articulation, and the left subclavian artery commencing 
from the arch of the aorta behind the lower part of the manu- 
brium sterni. The artery arches up over the apex of the lung, 
and passing between scalenus anticus and medius, it ends at the 
lower border of the first rib by becoming the axillary artery. 
The scalenus anticus, in crossing the subclavian artery divides it 
into three parts the first part being internal to the muscle, the 
second behind it, and the third on the external side. The 
third part of the artery is separated from scalenus medius by 
the cords of the brachial plexus. 

Branches. From the first part : 

Vertebral, thyroid axis, internal mammary. 
From the second part : Superior intercostal. 

The Vertebral artery arises from the subclavian artery just 
between scalenus anticus and longus colli. It passes backwards 
;and upwards through the foramina in the transverse processes 
of the cervical vertebrae, and entering the foramen magnum, ter- 
minates by uniting with its fellow of the opposite side to form 
the basilar artery. The basilar artery divides again, and the 
branches are united by the posterior communicating arteries to 
the internal carotid arteries to form the Circle of Willis for the 
free supply of the brain. 

The Thyroid Axis is a very short trunk, which ends by 
dividing into three the inferior thyroid, transverse cervical, 
and suprascapular which supply the shoulder and adjacent 
parts. 

10 



146 



HANDBOOK OF ANATOMY 



The Internal Mammary artery passes down on the pleura sup- 
plying the adjacent parts the diaphragm and the upper part 
of the anterior abdominal wall. 

Thfe Superior Intercostal artery passes backwards over the 
pleura to the neck of the first rib. There it divides into two 
branches for the supply of the upper two intercostal spaces. 

The Branches of the Thoracic Aorta are divided into two 
groups visceral and parietal. The visceral branches supply the 
bronchi, oesophagus, and pericardium, and several small branches 
to structures in the vicinity. The parietal supply the inter- 
costal muscles and the upper surface of the diaphragm. 

The Intercostal arteries, of which there are nine pairs, supply 
the nine lower intercostal spaces. Each artery passes back- 
wards behind the pleura and runs in the groove at the lower 
border of each rib. The Subcostal pair of arteries are in series 
with this, and run in the groove on the twelfth rib. 

The Branches of the Abdominal Aorta are in two groups 
visceral and parietal. The visceral branches supply the abdom- 
inal organs, the parietal branches supply the abdominal walls. 



Visceral. 


Parietal. 


Paired. 


Unpaired. 


Paired. 


Unpaii'ed. 


Suprarenal 


Cceliac axis 


Inferior phrenic 


Middle sacral 


Renal 


Superior mesenteric 


Lumbar (four pairs) 




Spermatic or 


Inferior mesenteric 


Common iliac 




Ovarian 









The order in which the branches arise from the abdominal 
aorta is as follows : 

1. Inferior phrenic. 

2. Cceliac axis. 

3. Middle suprarenal. 

4. Superior mesenteric. 

5. Eenal. 

6. Spermatic or ovarian. 

7. Inferior mesenteric. 

8. Middle sacral. 

9. Common iliac. 



ABDOMINAL AOETA 



147 



The Paired Parietal Branches. The Inferior Phrenic arteries 

are the first branches which curve off the aorta as it enters 

the abdomen. They supply the under surface of the diaphragm. 

The Lumbar arteries, of which there are usually four pairs, 

arise in series with the intercostal arteries. They pass back- 



Diaphragm 

Superior Capsular 

Arteries 
Suprarenal Body 

Mid. Capsular Artery 

Inf. Capsular Artery 

Renal Artery. 

Inferior Vena Cava 
Right Spermatic Artery. 



Right Ureter 
Aorta 



Right Common Iliac. 
Artery 




External Iliac Artery 



External Iliac Vein 



Inf. Phrenic Arteries 
Coeliac Axis 

Superior Mesenteric 
Artery 



. .Lumbar Artery 

. _Quadratus Lumborum 
. Psoas Magnus 

..Inferior Mesenteric 
Artery 

..Iliacus 
.Left Spermatic Artery 



'Left Common Iliac Vein 
"'-.Middle Sacral Artery 



Bladder 



Rectum 

FIG. 57. THE ABDOMINAL AORTA. 

wards over the bodies of the lumbar vertebrae and between the 
adjacent transverse processes. They pass behind psoas and 
cross quadratus lumborum to get between the muscles of the 
anterior abdominal wall. 

The Common Iliac arteries are formed by the bifurcation of 
the aorta at the lower border of the fourth lumbar vertebra. 



148 HANDBOOK OF ANATOMY 

They terminate opposite the lumbo-sacral joint by dividing into 
external and internal iliac. The common iliac arteries lie on the 
bodies of the fourth and fifth lumbar vertebrae and on psoas, 
and are separated anteriorly and externally from the coils of the 
small intestine by the peritoneum. 
Branches. Internal iliac. 
External iliac. 

The Internal Iliac artery arises opposite the lumbo-sacral 
articulation and passes down into the true pelvis, terminating 
opposite the upper border of the great sciatic notch by dividing 
into anterior and posterior divisions, giving off numerous 
branches which supply the pelvic wall and viscera, buttock, 
thigh, and external genital organs. 

Posterior division 

Parietal : Ilio-lumbar ~\ supply the muscles of the iliac 
Lateral-sacral Jfossa and front of sacrum. 
Gluteal, passes out above pyriformis to supply 
the gluteal muscles. 

Anterior division 

Visceral : supply the bladder and internal genital organs. 
Parietal : Obturator, supplies the obturator muscles. 

Sciatic, passes out below pyriformis and sup- 
plies the muscles on the upper part of the 
thigh. 

Internal pudic passes out below pyriformis, 
and, crossing the ischial spine with the 
pudic nerve, it enters and supplies the 
perineum. 

The External Iliac artery arises opposite the sacro-iliac joint, 
and, passing outwards and forwards along the brim of the 
pelvis, it passes under the mid-point of Poupart's ligament and 
becomes the femoral artery. It lies on psoas and iliacus, and is 
separated from the colon and small intestine by the peritoneum. 

Branches. Deep epigastric and deep circumflex iliac supply 
the muscles and skin of the anterior abdominal wall. 



ABDOMINAL AORTA 149 

The Unpaired Parietal Branch. The Middle Sacral artery 
is a small artery arising from the back of the aorta just before 
its bifurcation. It passes down the middle of the sacrum, sup- 
plying the muscles and joints in the vicinity. 

The Paired Visceral Branches. The Suprarenal arteries 
consist of three pairs of arteries for the supply of the suprar- 
renal capsule. The middle pair arises from the aorta direct, 
the others are branches of adjacent arteries. 

The Renal arteries arise opposite the second lumbar vertebra 
just below the superior mesenteric. Each passes transversely 
outwards over the crus of the diaphragm and the upper part 
of psoas to the hilum of the kidney. The right artery is a 
little longer than the left and often lower in position. It passes 
behind the inferior vena cava, the head of the pancreas, and 
the middle of the duodenum. The left artery lies behind the 
pancreas. 

The Spermatic or Ovarian arteries arise just below the renal 
arteries. The spermatic arteries run downward and outwards 
through the inguinal canal to supply the testicles. The ovarian 
arteries are much shorter, and pass straight down into the pelvis 
and supply the ovaries. 

The Unpaired Visceral Branches. The Coeliac Axis arises 
from the front of the aorta just after it has entered the ab- 
domen. It is very short (about half an inch), and divides 
almost at once into three branches : 

1. Gastric. 

2. Splenic. 

3. Hepatic. 

The Gastric artery runs upwards and to the left to the oeso- 
phagus, and passes along the smaller curvature of the stomach 
between the layers of the small omentum to join the pylorio 
branch of the hepatic artery. 

The Splenic artery runs behind the stomach along the upper 
border of the pancreas. It passes between the two layers of 
the lieno-renal ligament and enters the hilum of the spleen. 

The Hepatic artery runs along the head of the pancreas to 
the first part of the duodenum. It then passes upwards to the 



150 



HANDBOOK OF ANATOMY 



transverse fissure of the liver and divides into right and left 
branches. It gives off two branches the pyloric, which goes to 
the pylorus and supplies both sides of the stomach ; the gastro- 
duodenal, whose terminal branches supply the larger curvature of 
the stomach, the head of the pancreas, and the duodenum. 




FIG. 58. THE INFERIOR MESENTERIC ARTERY AND ITS BRANCHES 
(AFTER TIEDEMANN). 



1. Superior Mesenteric Artery 

2. Middle Colic 

3. Inferior Mesenteric 

4. Left Colic 

5. Arteriae Sigmoideae 



6. Superior Hemorrhoidal 

7. Transverse Colon 

8. Descending Colon 

9. Iliac Colon 
10. Pelvic Colon 



The Superior Mesenteric artery arises half an inch below the 
cceliac and opposite the first lumbar vertebra. It crosses 
obliquely downwards over the head of the pancreas to the root 
of the mesentery. It gives off numerous branches which supply 



VEINS 151 

the duodenum, small intestine, and ascending and transverse 
colons. 

The Inferior Mesenteric artery arises a short distance above 
the bifurcation of the aorta. It passes downwards over the left 
psoas and becomes the superior haemorrhoidal. It supplies the 
descending colon and the rectum. 

f 

The Veins. 

The veins are formed by the aggregation of the capillaries, 
and return the blood to the heart. They,, like the arteries, are 
arranged in two sets pulmonary and systemic. The pulmonary 
veins enter the left auricle of the heart by four openings, and 
the systemic veins i.e., the coronary sinus, and superior and 
inferior venae cavae enter the right auricle by three openings. 

The Pulmonary veins are found in the alveoli of the lungs, 
and form a single large vessel for each lobe. In the root of 
the right lung the veins from the upper, and middle lobes join 
together,, so that two veins pass out from the root of each 
lung to enter the left auricle. 

Systemic Veins. The systemic veins, three in number, all 
enter the right auricle. 

The coronary sinus returns the blood from the walls of the 
heart only. The superior vena cava returns the blood from the 
head, neck, upper limbs, thoracic wall, and a part of the pos- 
terior abdominal wall. The inferior vena cava returns blood 
from the lower limbs, and the walls and organs of the abdomen 
and pelvis. 

The veins of the body wall and limbs are arranged in two 
sets superficial and deep. The superficial veins run in the 
superficial fascia, and the deep veins accompany the arteries, 
usually as venae comites. The superficial veins ultimately pierce 
the deep fascia to unite with the deep veins. The visceral veins, 
of which there is usually one accompanying the artery, end 
in the deep systemic veins, with the exception of the portal 
vein. 

The Coronary Sinus lies between the left auricle and left 
ventricle, and terminates in the lower and back part of the 



152 HANDBOOK OF ANATOMY 

right auricle. It receives the blood from the walls of the 
heart. 

The Superior Vena Cava is formed at the lower border of 
the first right costal cartilage by the junction of the two in- 
nominate veins, descends to the level of the third right costal 
cartilage, where it enters the right auricle. Anteriorly it is 
overlapped by the right lung, and pleura and the ascending 
aorta. 

Tributaries. Vena azygos major. 

Small pericardial veins. 

The Vena azygos major is the upward continuation of a vessel 
known as the right ascending lumbar vein, which connects 
together the lumbar veins of the right side. It passes through 
the aortic opening in the diaphragm, up the posterior thoracic 
wall, and arches over the root of the right lung to enter the 
superior vena cava. It receives the right intercostal veins and 
the vena azygos minor superior and inferior, which receive the 
lumbar and intercostal veins of the left side. 

The Innominate Vein of each side is formed behind the 
sternal end of the clavicle by the union of the internal jugular 
with the subclavian vein. The two innominate veins unite to 
form the superior vena cava behind the first right costal 
cartilage; consequently the left one is longer than the 
right. 

The tributaries are the veins corresponding to the arteries in 
that region viz., internal mammary, inferior thyroid, vertebral,, 
pericardial, and bronchial. 

The Internal Jugular vein commences as the direct continua- 
tion of the lateral sinus of the brain, and passes through the 
jugular foramen to reach the neck, uniting behind the sternal 
nd of the clavicle with the subclavian vein to form the -innomi- 
nate vein. It lies on the outer side of the common carotid 
artery, and on the left side overlaps it in front at its 
lower end. 

Tributaries. Sinus in the brain. 

Veins from the wall of the pharynx, the tongue,, 
and the veins accompanying the thyroid 
arteries. 



JUGULAR VEINS 



153 



Common facial, formed by union of facial and 
a terminal branch of the temporo-maxillary 
veins, which drain the muscles of the face and 
fore-part of the scalp. 

Occipital vein, which drains the back part of 
the scalp. 



Posterioi Auricular Lym-.^ 
phatic Glands 

Occipital Vein ~\^L. 



Occipital Lymphatic 

Gland 
Posterior Auricular Vein 

Posterior Division of.. 

Temporo- Maxillary 

Vein 

Superficial Cervical ^="~~ 
Lymphatic Glands "~~"-- 



Posterior Jugular _ 
Vein 



External Jugular Vein -- 



Transverse Cervical 
Vein 




____ Frontal Vein 

Supra-orbital Veia 



_______ Angular Vein 



Superficial Temporal 

Vein 

Internal Maxillary 
Vein 



Temp. -Maxillary Vein 
-Facial Vein 

Ant. Div. of Temporo- 

Maxillary Vein 
Submax. Lymph. Glands 
Common Facial Vein 
Internal Jugular Vein 
Lingual Vein 

Superior Thyroid Vein 
Middle Thyroid Vein 

Anterior Jugular Vein 

Suprasternal Lym- 
phatic Gland 



Suprascapular Vein and Supraclavicular 
Lymphatic Glands 

FIG. 59. VEINS AND GLANDS OF HEAD AND NECK. 



The Subclavian vein is the direct continuation of the axillary 
vein. It commences at the lower border of the first rib and 
passes in front of scalenus anticus, which separates it from the 
artery, and terminates behind the sternal end of the clavicle 
by uniting with the internal jugular vein to form the innomi- 
nate vein. 



154 HANDBOOK OF ANATOMY 

Tributary. External jugular formed on the surface of the 
sterno-mastoid by the union of the terminal branch of the 
temporo-maxillary with the posterior auricular vein, which drain 
the outer side of the head and neck. 

The Inferior Vena Cava is formed opposite the right side 
of the body of the fifth lumbar vertebra behind and external 
to the right common iliac artery by the union of the common 
iliac veins. It passes up the posterior wall of the abdomen 
to the right of the aorta and on the right crus of the dia- 
phragm, and passes through the latter at the level of the eighth 
dorsal vertebra. It then pierces the pericardium and enters 
the lower and back part of the right auricle. The vessel lies 
below on the bodies of the lumbar vertebrae, the right psoas, 
and the right crus of the diaphragm, the right renal artery, 
and suprarenal capsule. Anterior to it are the right common 
iliac artery, the third part of the duodenum, head of the pan- 
creas, the portal vein, the first part of the duodenum, and the 
posterior surface of the liver. On its left side are the aorta and 
the left crus of the diaphragm. 

Tributaries. Hepatic. 

Inferior phrenic. 

Suprarenal. 

Renal. 

Lumbar. 

Spermatic or ovarian. 

The Hepatic veins are two in number, which .open into the 
inferior vena cava just below the diaphragm, and bring the 
blood from the liver which has entered it through the hepatic 
artery and portal vein. 

The Inferior Phrenic veins are formed by the venae comites of 
the arteries supplying the diaphragm. 

The Suprarenal veins are one each from the suprarenal 
capsules. Sometimes the one on the left side enters the left 
renal vein. 

The Renal veins each issue from the hilum of the kidney, the 
left one being longer than the right. The left one crosses in 
front of the left psoas, the left crus of the diaphragm, and 
the aorta just below the superior mesenteric artery, and lies 



PORTAL SYSTEM 155 

behind the pancreas and the last part of the duodenum. The 
right renal vein passes behind the duodenum. 

The Lumbar veins, of which there are four pairs, are formed 
by tributaries from the lateral and posterior walls of the ab- 
domen. They are also connected together by the azygos veins, 
.anastomosing vessels passing upwards. 

The Spermatic or Ovarian veins are formed by the pampini- 
form plexuses surrounding the testicles or ovaries. The vein 
on the right side enters the inferior vena cava, that on the left 
usually enters the left renal vein. 

The Common Iliac veins are formed by the union of the 
external iliac and internal iliac veins opposite the brim of the 
pelvis behind the internal iliac artery. They pass upwards and 
inwards, and unite to form the inferior vena cava opposite the 
fifth lumbar vertebra. 

Tributaries. External iliac. 
Internal iliac. 

Ilio-lumbar, small veins from the iliac fossa and 
adjacent parts. 

The Internal Iliac vein is formed at the upper border of the 
great sciatic notch by the union of veins corresponding to the 
branches of the internal iliac artery, except the ilio-lumbar 
branches. It lies behind and slightly to the inner side of the 
corresponding artery. 

The External Iliac vein is the continuation of the femoral vein, 
:and commences on the inner side of the femoral artery. 
Passing upwards and inwards along the brim of the pelvis, it 
ends by joining the internal iliac to form the common iliac 



The Portal System. The portal vein is formed by tribu- 
taries from the whole of the alimentary canal (except the lower 
part of the rectum), the spleen and the pancreas, and conveys 
the blood thus collected to the liver. The tributary veins corre- 
spond at first with the arteries supplying these organs, but the 
terminal veins differ somewhat. The inferior mesenteric vein 
joins the splenic vein, and they join with the superior mesentric 
Tein to form the portal vein. The portal vein is a short wide 
vessel about three inches long, which commences behind the 



156 HANDBOOK OF ANATOMY 

neck of the pancreas in front of the left border of the inferior 
vena cava. It passes upwards behind the pancreas, duodenum,, 
and common bile-duct, and enters the transverse fissure of the 
liver. 

The Middle and Inferior Haemorrhoidal veins which drain the 
lower part of the rectum, enter the internal iliac vein, and thus 
connect the vena cava and portal systems. 



SECTION X 
THE BLOODVESSELS OF THE UPPER LIMB 

Arteries of the Upper Limb. 

THE blood-supply of the upper limb is derived from the con- 
tinuation of the subclavian artery, which at the lower border 
of the first rib changes its name and becomes the axillary 
artery. 

Axillary Artery. From the lower border of the first rib to 
the lower border of the teres major. 

The axillary artery passes through the axillary space, and lies 
on, successively, upper digitation of serratus magnus, sub- 
scapularis, latissimus dorsi, teres major, and is covered by pec- 
tor alis major and minor. 

The pectoralis minor muscle crosses the middle third of the 
artery and divides it into three parts. 

The three cords of the brachial plexus lie respectively to the 
inner, outer, and posterior sides of the artery. 

The axillary vein lies along the inner side of the artery. 

Branches. From first and second parts : 

Several thoracic branches to supply the neighbouring parts. 
From third part : 

1. Subscapular, which arises opposite the lower border of the 
scapularis and supplies the adjacent muscles and inner wall of 
axillary space. 

2. Anterior and Posterior Circumflex, which enclose the sur- 
gical neck of the humerus and supply the shoulder-joint and 
adjacent muscles (see Fig. 6). 

The axillary artery is continued as the brachial artery, which 
passes down to supply the upper arm. 

Brachial Artery. From the lower border 'of teres major to 
the antecubital fossa, where, at the level of the neck of the 

157 



158 HANDBOOK OF ANATOMY 

radius, it terminates by dividing into the radial and ulnar 
arteries. 

The brachial artery passes downwards and outwards, and lies 
on, successively, long head of triceps, insertion of coraco- 
brachialis, brachialis anticus, and is covered by the inner border 
of biceps. 

In its upper half the median and ulnar nerves lie re- 
spectively on the external and internal sides of the artery, and at 
the middle the median nerve crosses over to the inner side of 
the artery, while the ulnar nerve passes to the back of the arm, 

Branches. 1. Superior Profunda, runs downwards and back- 
wards with the musculo-spiral nerve to the back of the arm. 

2. Inferior Profunda, runs downwards and backwards with the 
ulnar nerve to the back of the elbow-joint. 

3. Anastomotic pierces the internal intermuscular septum and 
passes also to the back of the elbow-joint. 

4. Small muscular branches are given off to the adjacent 
muscles. 

Radial Artepy. The radial artery is the smaller of the two 
terminal branches of the brachial artery, but the more direct 
continuation of the parent trunk. It passes down the outer 
side of the forearm, and at the wrist winds round the trapezium 
to reach the back of the hand ; it then comes back through the 
first interosseous space, and anastomoses with the deep branch 
of the ulnar artery to form the deep palmar arch. 

It lies successively on insertion of biceps, supinator brevis, 
pronator radii teres, radial head of flexor sublimis digitorum, 
flexor longus pollicis, pronator quadratics, anterior ligament of 
wrist- joint. 

It is covered by inner border of supinator longus (brachio- 
radialis) in its upper two-thirds. The lower third is sub- 
cutaneous. 

The radial nerve is in relation to the artery in its middle 
third, and lies on its outer side. 

Branches. 1. Superficial Volar, which arises just above the 
wrist, and, passing down over the ball of the thumb, anasto- 
moses with the superficial branch of the ulnar artery to form 
the superficial palmar arch. 



ULNAR ARTERY 159- 

2. Anterior Carpal, given off at the wrist and anastomoses with 
a similar branch of the ulnar artery. 

3. Posterior Carpal, a small branch which passes backwards 
and anastomoses with a similar branch from the ulnar artery to 
form the posterior carpal arch. 

4. Muscular branches for the supply of the adjacent muscles. 
Ulnar Artery. The larger of the two terminal branches of 

the brachial artery arises in the antecubital fossa, and terminates 
in the palm of the hand by forming the palmar arches. 

It lies successively on brachialis anticus, flexor profundus 
digitorum, pronator quadratus, anterior annular ligament. 

It is covered by the (pronator radii teres, flexor sublimis digi- 
torum, flexor carpi radialis, palmaris longus, flexor carpi ulnaris) 
superficial group of flexor muscles from internal condyle of 
humerus, and in its lower third is subcutaneous. 

The median nerve crosses it above, being separated from the 
artery by the deep head of pronator radii teres, and on its inner 
side lies the ulnar nerve. 

Branches. 1. Common Inter 'osseous, a very short trunk arising 
in the antecubital fossa, and dividing into the anterior and 
posterior interosseous arteries. 

(a) The Anterior Interosseous artery runs down on the an- 
terior surface of the interosseous membrane to the upper border- 
of pronator quadratus, where it pierces the membrane and 
terminates in the posterior carpal arch. 

(b) The Posterior Interosseous artery passes down the back of 
the forearm between the superficial and deep muscles which it 
supplies, and ends by anastomosing with the anterior interosseous 
artery and the posterior carpal arch. 

2. Anterior Carpal, a small branch given off just above the 
wrist, which anastomoses with a similar branch from the radial 
artery to form the anterior carpal arch. 

3. Posterior Carpal, a small branch which passes backwards 
and anastomoses with a similar branch from the radial artery 
to form the posterior carpal arch. 

The ulnar artery crosses over the annular ligament, and ter- 
minates in the palm of the hand by dividing into superficial 
and deep branches. 



160 HANDBOOK OF ANATOMY 

The Superficial Palmar Arch is formed at the level of the 
distal border of the abducted thumb by the anastomosis of the 
superficial volar branch of the radial artery with the superficial 
terminal branch of the ulnar artery. 

It lies on flexor brevis minimi digiti, opponens minimi digiti, 
and tendons of flexor sublimis digitorum. It is covered by 
palmar fascia and integument. 

The Deep Palmar Arch is formed about three-quarters of an 
inch above the level of the superficial arch, by the anastomosis 
of the radial artery with the deep terminal branch of the ulnar 
artery. 

It lies deeply in the palm on the bases of the metacarpal 
bones and the interossei muscles, and is covered by the flexor 
tendons. From the arches branches are given off for the 
supply of the muscles and fingers. 

The back of the hand and fingers are supplied by branches 
given off from the radial artery while it lies on the back of the 
trapezium. 

Veins of the Upper Limb. 

The veins of the upper limb are arranged in two sets super- 
ficial and deep. Both sets open eventually into a common 
trunk, known as the axillary vein, which continues as the sub- 
clavian vein to the innominate vein. 

The Deep veins consist of vense comites arranged in the 
usual way, which open into the axillary vein. 

The Axillary vein commences as the continuation of the 
basilic vein opposite the lower border of teres major, and ter- 
minates at the lower border of the first rib by becoming the 
subclavian vein. Its muscular relations are similar to those 
of the axillary artery, from which it is separated in the lower 
part of its course by the ulnar nerve, and above by the inner 
cord of the brachial plexus. To the inner side of the axillary 
vein lie the groups of axillary glands. 

Tributaries. 1. Vense Comites of the brachial artery at the 
lower border of the subscapularis muscle. 

2. Cephalic vein at the upper border of pectoralis minor. 



ULNAR VEINS 161 

3. Tributaries corresponding to the branches of the axillary 
artery. 

The Superficial veins commence in the superficial fascia of 
the palm and dorsum of the hand, and of the fingers. 

The superficial veins of the palm and palmar surface of the 
fingers are relatively small, and after forming a small irregular 
plexus end in the median and anterior ulnar veins of the 
forearm. 

On the dorsal aspect of the fingers are the dorso-lateral 
veins, which ascend along the dorso-lateral borders of each digit. 
They receive tributaries from all the tissues of the fingers, and 
terminate in a dorsal venous plexus, or arch, which lies at the 
level of the bases of the four inner metacarpal bones. The arch 
finally terminates in the radial and posterior ulnar veins of 
the forearm. 

There are four superficial veins in the forearm : 

1. The Median vein which commences on the dorsal aspect 
of the base of the thumb. It turns round the radial border of 
the wrist, and, passing up the middle of the forearm, terminates 
by dividing into the median cephalic and median basilic veins. 

Tributaries. (I) Deep Median vein, a short vessel which con- 
nects the deep and superficial veins at the elbow-joint. 
(2) Tributaries from the adjacent tissues. 

2. The Radial vein commences in the dorsal venous plexus of 
the hand and runs up the outer border of the forearm, receiving 
tributaries from the adjacent tissues. It ends at the outer side 
of the elbow by joining the median cephalic vein to form the 
cephalic vein. 

8. The Anterior Ulnar vein commences at the base of the 
little finger, and, passing up the ulnar side of the anterior surface 
of the forearm, ends in -the basilic vein. 

4. The Posterior Ulnar vein (usually considerably larger than 
the anterior) commences in the dorsal venous plexus, and 
ascends along the dorsal side of the ulnar aspect of the fore- 
arm. It terminates by joining the median basilic vein to form 
the basilic vein. 

The median cephalic and median basilic veins are formed by 
the division of the median vein ; they are both short vessels. 

11 



162 HANDBOOK OF ANATOMY 

The median cephalic vein passes upwards and outwards, and 
opposite the external condyle of the humerus joins the radial 
vein to form the cephalic vein. The median basilic vein similarly 
forms the basilic vein opposite the internal condyle by joining 
with the anterior and posterior ulnar veins. 

The upper arm contains only two large veins. 

1. The Basilic vein commences opposite the inner side of the 
bend of the elbow, and passing upwards on the inner side of 
biceps to the middle of the arm it pierces the deep fascia, and 
opposite the lower border of teres major becomes the axillary 
vein. 

2. The Cephalic vein commences at the outer side of the bend 
of the elbow and ascends* on the outer side of biceps. It then 
pierces the deep fascia, and passing between the adjacent 
borders of the deltoid and pectoralis major muscles, it pierces 
the costo-coracoid membrane and enters the third part of the 
axillary vein. 



SECTION XI 
THE BLOODVESSELS OF THE LOWER LIMB 

Arteries of the Lower Limb. 

THE blood-supply of the lower limb is derived from the con- 
tinuation of the external iliac artery, which, passing under 
Poupart's ligament, changes its name and becomes the femoral 
artery, which passes from the lower border of Poupart's liga- 
ment to the opening in the insertion of adductor magnus. 

The Femoral artery passes through Scarpa's triangle, then 
enters Hunter's canal. 

Scarpa's triangle is a muscular space situated in the upper 
anterior portion of the thigh : it is triangular with the apex 
downwards ; the base is formed by Poupart's ligament, the outer 
side by sartorius, the inner side by adductor longus ; in the 
floor are seen ilio-psoas, pectineus and adductor brevis ; the con- 
tents are femoral artery and vein, anterior crural nerve, and 
lymph glands. 

In Scarpa's triangle it lies on, successively, posterior part of 
femoral sheath, pubic portion of fascia lata, psoas, pectineus, 
adductor longus (upper part), and is covered by skin and fascia, 
superficial glands and vessels. On the outer side of the artery 
above lies the anterior crural nerve, and lower down the internal 
;saphenous nerve. 

The femoral vein lies behind the artery in the lower part of 
"Scarpa's triangle, passes to its inner side above, and is separated 
from the artery by the outer septum of the femoral sheath. 

Hunter's canal is a potential space between the adductor 
muscles and vastus internus, covered by sartorius ; the contents 
are the femoral artery and vein, and long saphenous nerve. 

In Hunter's canal the artery lies on, successively, adductor 

163 



164 HANDBOOK OF ANATOMY 

longus, adductor magnus, and is covered by sartorius, and on the 
outer side lies vastus internus. 

The long saphenous nerve enters the canal with the artery,, 
and crossing over passes out on its inner side. 

The femoral vein lies behind the artery on its outer side below 
and on its inner side above. 

Branches (in Scarpa's triangle) : 

(1) Superficial external pudic, 

(2) Superficial epigastric, 

(3) Superficial circumflex iliac, 

all of which supply the lower part of the abdominal wall and 
superficially the external genital organs, 

(4) Muscular, 

(5) Deep external pudic, 

(6) Profunda, 

all of which supply the muscles on the front and inner side of 
the thigh, the profunda sending off a number of perforating 
branches, which curve backwards and outwards round the femur. 

In Hunter's canal (near the lower end) : 

(7) Anastomotica magna, which anastomoses with the termina- 
tions of the other branches and the articular branches of the 
popliteal artery. 

The femoral artery is continued as the popliteal artery, which 
lies in the popliteal space at the back of the knee-joint. 

The Popliteal Space is a diamond-shaped space at the back of 
the knee, covered in by a very strong fascia; above, the 
Boundaries are the ham-strings, biceps on the outer side, semi- 
tendinosus and semimembranosus on the inner side ; below, the 
two heads of the gastrocnemius ; the floor is formed by the 
posterior surface of the femur, and popliteus. The contents are 
the popliteal artery and vein, the popliteal nerves and lymphatic 
glands. 

Popliteal Artery. From the opening in the insertion of 
adductor magnus to the lower border of popliteus, where it ter- 
minates by dividing into the anterior and posterior tibial arteries. 

The artery descends with an outward inclination to the space 
between the condyles of the femur, and then continues vertically 
downwards. It is in contact in front with the popliteal surface 



POSTERIOR TIBIAL ARTERY 165 

of the femur, posterior ligament of knee-joint, posterior surface 
of popliteus, and is covered by outer border of semimembranosus, 
and adjacent borders of heads of gastrocnemius. On its outer 
side above lies the internal popliteal nerve, which crosses its 
middle and lies on its inner side below. 

The Popliteal Vein lies behind the artery below, then crosses 
its middle, lying between it and the internal popliteal nerve, and 
passes upwards on its outer side. 

Brandies. Muscular to the adjacent parts. 

Articular to the knee-joint (five in number) . 

Posterior Tibial Artery. The larger of the two terminal 
branches of the popliteal artery commences at the lower border 
of popliteus and terminates at the lower border of the internal an- 
nular ligament midway between the tip of the internal malleolus 
and the os calcis. It ends by dividing into the internal and 
external plantar arteries. The artery lies between the deep and 
superficial groups of muscles on the back of the leg, and is in 
contact in front from above downwards with tibialis posticus, 
flexor longus digitorum, posterior surface of tibia, posterior 
ligament of ankle-joint. It is covered by, successively, gas- 
trocnemius, soleus, skin and fascia, internal annular ligament, 
origin of abductor hallucis. 

The internal popliteal nerve lies above on the inner side of the 
artery, and crosses it about an inch and a half below its origin, 
and is continued down its outer side. 

The artery is accompanied by venae comites, one on each side. 

Beneath the internal annular ligament the tendons of tibialis 
posticus and flexor longus digitorum lie in the front of the artery 
and that of flexor longus hallucis behind it. 

Branches. 1. Muscular to soleus and the deep muscles. 

2. Cutaneous to skin of back of leg. 

3. Internal Malleolar to the inner surface of the 

internal malleolus, which anastomoses with a 
similar branch of the anterior tibial artery. 

4. Peroneal, the largest branch of the posterior 

tibial artery, arises about an inch below the 
lower border of popliteus, and, curving 
outwards, supplies the peroneal muscles. 



166 HANDBOOK OF ANATOMY 

Internal Plantar Artery. The smaller of the two terminal 
branches of the posterior tibial artery passes forwards along the 
inner side of the foot between abductor hallucis and flexor 
brevis digitorum to the head of the first metatarsal bone, where 
it unites with a branch of the dorsalis pedis artery, the termina- 
tion of the anterior tibial artery. 

External Plantar Artery. The larger of the two terminal 
branches runs outwards and forwards between flexor brevis 
digitorum on the inner side and accessorius and abductor minimi 
digiti on the outer side to the base of the fifth metatarsal bone, 
It then passes inwards across the bases of the metatarsal bones, 
where on the outer side of the first one it terminates by anas- 
tomosing with the dorsalis pedis artery, thus forming the plantar 
arch (see Fig. 24). 

Branches. 1. Internal calcaneal. 

2. Muscular. 

3. Cutaneous. 
From the arch 

4. Digital branches four in number running on the outer 
side of the little toe and the plantar surfaces of the interosseous 
muscles. 

5. Perforating arteries three in number anastomosing with 
the dorsal arteries. 

6. Articular to the tarsal joints. 

Anterior Tibial Artery. The smaller of the two terminal 
branches of the popliteal artery passes forward above the inter- 
osseous membrane and runs down the front of the leg and 
terminates by becoming the dorsal artery of the foot from the 
lower border of popliteus to the front of the ankle. It lies on, 
successively, anterior surface upper two-thirds of interosseous 
membrane, shaft of tibia, anterior ligament of ankle-joint. 

On the inner side of the upper two-thirds lies the tibialis 
anticus, and in the lower third the extensor longus hallucis 
crosses over and lies on the inner side. On the outer side of the 
upper two-thirds lie respectively extensor longus digitorum and 
extensor longus hallucis, and the last part of the artery lies 
between the tendons of these two muscles. 

The anterior tibial nerve lies on the outer side of the artery,, 



FEMORAL VEIN 167 

and at the ankle lies between it and the outermost tendon of 
extensor longus digitorum. The artery is accompanied by venaa 
comites. 

Branches. 1. Muscular to adjacent parts. 

2. Cutaneous to skin of front of leg. 

3. Internal malleolar anastomoses with posterior 

tibial. 

4. External malleolar anastomoses with peroneal. 
Dorsalis Pedis artery is the direct continuation of the anterior 

tibial artery from the front of the ankle-joint to the posterior 
extremity of the first interosseous space, where it anastomoses 
with the external plantar artery to form the plantar arch. It 
lies on, successively, anterior ligament of the ankle-joint, head 
of the astragalus, navicular bone, inter cuneiform ligaments. 

It is covered by skin and fascia and the lower part of the 
anterior annular ligament. 

The internal terminal branch of the anterior tibial nerve lies 
on the outer side of the artery, between it and the extensor 
brevis digitorum. 

The tendon of extensor proprius hallucis lies on the inner side, 

Branches. 1. Cutaneous to skin of dorsum of foot. 

2. Dorsalis hallucis runs on first interosseus muscle and sup- 
pies first and second toes. 

3. Metatarsal arises just before termination of artery, and, 
running outwards, gives off branches to supply the digital clefts, 

Veins of the Lower Limb. 

The veins of the lower limb are arranged in a similar manner 
to those of the upper limb, in two groups superficial and deep. 

The Deep veins consist of venge comites accompanying all the 
arteries in the leg, which unite to form the Popliteal vein at the 
lower border of popliteus. The popliteal vein passes upwards 
through the popliteal space, at first on the inner side of the 
artery and above on the outer side ; it then passes through the 
opening in adductor magnus and becomes the femoral vein. 

The Femoral vein is the direct continuation of the popliteal 
vein. It ascends through Hunter's canal and Scarpa's triangle, 



168 HANDBOOK OF ANATOMY 

and, passing under Poupart's ligament on the inner side of the 
femoral artery, becomes the external iliac vein. 

The Superficial veins of the lower limb are two in number 
the internal or long saphenous vein and the external or short 
saphenous vein. 

The veins on the toes are arranged similarly to those of the 
fingers, and form plexuses on the sole and dorsum of the foot, 
which enter the external and internal saphenous veins re- 
spectively. 

The Internal Saphenous vein is formed by the veins on the 
inner side of the sole and dorsum of the foot. It passes upwards 
in front of the internal malleolus, and, passing behind the inner 
border of the tibia, it runs up the leg to a point behind the 
internal condyle of the femur. Then, coursing outwards and 
forwards, it passes up the inner side of the thigh and terminates 
in the upper part of Scarpa's triangle in the femoral vein. 

The External Saphenous vein is formed by the veins on the 
outer side of the sole and dorsum of the foot. It passes behind 
the external malleolus and up the back of the leg to the lower 
part of the popliteal space, where it enters the popliteal vein. 



SECTION XII 
LYMPHATIC SYSTEM 

THE Lymphatic System is the means by which the liquid 
portion of the blood which exudes into the intercellular spaces 
is gathered up and returned to the blood, passing through the 
lymphatic glands on its way. The lymph capillaries gather up 
the fluid from the spaces, and enter a definite system of vessels, 
which carry the lymph to the groups of glands. Vessels leave 
these glands, and the lymph is carried to its final destination 
in the big veins at the root of the neck by one of the two ter- 
minal lymph vessels. 

The Thoracic Duct is the larger of the two terminal vessels. 
It commences in the Receptaculum chyli (really a dilation of 
the vessel) which lies beneath the right crus of the diaphragm. 
The duct passes through the aortic opening in the diaphragm, 
and passes up on the right of the vertebral column. At the level 
of the fifth thoracic vertebra it crosses over to the left side, and 
passes up to enter the left innominate vein. The Receptaculum 
chyli receives the lymph from the lower extremities and the 
whole of the abdomen. The thoracic duct receives lymph from 
the left half of the thorax, the left upper extremity, and the left 
side of the head and neck. 

The Right Lymphatic Duct is a very short vessel, not always 
present, about an inch long, which enters the right innominate 
vein. It receives lymph from the right half of the thorax, right 
upper extremity, and the right side of the head and neck. 

The Lymphatic Glands and their vessels are arranged in two 
sets superficial and deep and are usually to be found on the 
course of the big veins and large spaces where there is con- 
nective tissue. The two sets anastomose with one another freely. 

169 



170 HANDBOOK OF ANATOMY 

Head and Neck. 

Occipital Glands, upon the upper part of trapezius or corn- 
plexus, drain the occipital region of the scalp and upper and 
back part of the neck. 

Mastoid Glands, on the upper part of sterno-mastoid and the 
mastoid bone, drain the parietal region of the scalp and the ear. 

Facial Glands, small glands in different parts of the face, in- 
cluding several small groups situated beneath and behind the 
masseter muscle, draining the different parts of the face. 

Superficial Cervical Glands lie superficial to the sterno-mastoid 
along the course of the external jugular veins. They drain the 
superficial part of the neck and mastoid region. There are also 
numerous small groups draining the tongue, front of the neck,, 
pharynx, and larynx (see Fig. 59). 

Deep Cervical Glands are in two groups, one beneath the 
sterno-mastoid lying along the course of the internal jugular 
vein. The other, embedded among the cords of the brachial plexus,, 
is termed the supraclavicular group. These glands receive 
tributaries from the surrounding tissues and the groups of 
glands above them. 

Upper Extremity. 

Anteeubital Glands, two or three small glands in front of 
the elbow, which drain the anterior surface of the forearm. 
They are not always present. 

Axillary Glands. These are arranged in four groups (1) 
along the axillary vessels, (2) along the upper part of the axillary 
and the subclavian vessels, (3) between pectoralis major and 
serratus magnus, (4) along the subscapular vessels on the pos- 
terior wall of the axilla. They drain the upper limb and 
adjacent parts. 

The Superficial Lymphatic Vessels of the upper limb begin 
by fine plexuses on the fronts of the fingers and palms of the 
hand. These converge to form vessels running along the sides 
of the fingers and back of the hand, and finally larger vessels 
are formed which follow the course of the veins and receive 
tributaries from the surrounding tissues, passing up to join the 



LYMPHATIC GLANDS 171 

antecubital and axillary glands. The Deep Lymphatic Vessels 
commence in the deeper tissue, and follow the course of the 
deep vein to the glands. 

Lower Extremity. 

Anterior Tibial Gland, on the front of the upper part of- 
the interosseous membrane, drains the front of the leg. 

Popliteal Glands, several glands in the popliteal space lying 
along the course of the vessels. These receive the tributaries 
from the anterior tibial gland and from the calf of the leg and 
foot. 

Femoral Glands are in two sets superficial and deep. They 
are all in Scarpa's triangle, arranged along the course of the 
vessels and along Poupart's ligament. They drain the whole of 
the lower limb. 

The Lymphatic Vessels of the lower extremity are arranged 
in a very similar manner to those of the upper. 

Trunk. 

There are a large number of groups of glands in the 
abdomen and thorax which lie along the course of the vessels 
and in connection with the organs, and enter mainly the 
thoracic duct as described above. The lateral walls of the trunk 
are drained by the axillary and femoral groups of glands. The 
anterior walls are drained by some of the visceral groups, and 
the back is drained by groups of glands lying along the front 
of the vertebral column. 



SECTION XIII 

BRAIN, SPINAL CORD, NERVES OF TRUNK, AND 
SYMPATHETIC SYSTEM 

THERE are two nervous systems described in the body the 
cerebro-spinal and sympathetic. The cerebro -spinal can be 
divided into central and peripheral parts, the central part con- 



Cerebral Hemisphere 




/// Pons Varolii 

Medulla Oblongata 

FIG. 60. THE BRAIN (SIDE VIEW). 

sisting of the brain and spinal cord, which send branches to 

the periphery. The sympathetic system consists of two chains 

of ganglia which communicate with the peripheral part of the 

cerebro-spinal system by means of efferent and afferent branches. 

172 



BRAIN 



173 



The brain is enclosed by the cranium, and the lower and 
hind-part of the brain, called the medulla, is prolonged through 
the foramen magnum of the occipital bone into the vertebral 
canal. The upper part of the brain the cerebrum is the 
larger; it is divided longitudinally by a deep cleft into two 
halves, each of which are divided again into lobes, correspond- 



Olfactory Bulb 
Olfactory Tract 



Optic Nerve 



Optic Commissure -mnjpr 

Optic Tract 
Third Nerve 

Fourth Nerve 



Fifth Nerve 
Sixth Nerv 
Facial Nerve 
Pars Intermedia -' 

Auditory Nerve '" 
Glosso-pharyngeul Nerve - 
Pneumogastric Nerve 
Spinal Accessory Nerve 

Hypoglossal Nerve 



Locus Perforates - 
Anticus 



- Tuber Cinereum 




Corpus Albicans 
Crus Cerebri 

Locus Perforatus- 
Posticus 

Pons Varolii 



Medulla Oblongata 



Spinal Cord 



FIG. 61. BASE OF THE BRAIN. 



ing with, in shape and position, the bones of the cranium 
namely, frontal, parietal, temporal, and occipital. These are 
again subdivided by numerous clefts or sulci.' Beneath the 
occipital lobes of the cerebrum lies the cerebellum, or hind-brain, 
much smaller than the cerebrum. It also is divided longitu- 
dinally into two principal lobes, which are again subdivided by 



174 HANDBOOK OF ANATOMY 

: sulci, which, however, are very much shallower than those of 
the cerebrum. 

Looking at the base of the brain, it is seen that two thick cords 
of white matter issue from the cerebrum. These are called the 
cerebral peduncles, and joining them together is the pons 
varolii, which is seen to consist of transverse fibres, the ends 
of which pass into the cerebellum. Below the pons varolii is 
the upper end of the bulb or medulla oblongata, which lies on 
the upper aspect of the basilar process of the occipital bone. 

The medulla tapers somewhat sharply, and is continued as the 
spinal cord. 

From each side of the pons varolii and the medulla, issue 
the larger number of the twelve pairs of cranial nerves, which 
supply the tissues of the head and neck. 

In transverse section the brain is seen to consist of white 
matter with a covering about quarter of an inch thick of grey 
matter, both of which are folded into convolutions and sulci. 
There are also nuclei of grey matter embedded in the white. 
The cerebellum is of similar structure. 

The brain has three membraneous coverings, named, respec- 
tively, dura mater, arachnoid mater, and pia mater. 

The Dura Mater is a tough membrane which lines the inside 
of the cranium, and is closely attached to it. It dips down into 
the great longitudinal fissure, and forms a pocket, or sinus. It 
also sends a process into the fissure between the cerebrum and 
cerebellum, called the tentorium cerebelli, in the edges of 
which are found sinuses. These sinuses are for the collection 
of venous blood. 

The Arachnoid Mater is a more or less areolar structure which 
connects the pia mater with the dura mater. 

The Pia Mater is a very thin epithelium which covers the brain 
substance, and follows intimately all the convolutions and sulci. 
In it numerous small bloodvessels ramify. 

Blood-Supply of the Brain. 

The blood-supply of the brain is very free, and is derived 
from four large arteries the internal carotid and vertebral 
arteries of each side. These enter through the carotid canal in the 



SPINAL CORD 175 

temporal bone and the foramen magnum respectively. On the 
lower surface of the medulla they anastomose together to 
form the circle of Willis, from which branches are derived 
which supply freely the different parts of the brain. 

There are no veins proper in the brain ; the venous blood is 
collected in the blood-spaces or sinuses in the dura mater, which- 
finally leave the cranium by the jugular foramina as the internal 
jugular veins. 

The Spinal Cord. 

The spinal cord occupies the upper two-thirds of the verte- 
bral canal. It extends from the margin of the foramen magnum 
of the occipital bone to the level of the upper border of the 
second lumbar vertebra. At its upper end it is continuous with 
the medulla oblongata of the brain, at its lower end it tapers, 
forming a pointed extremity called the conus medullaris, from 
the end of which comes a slender thread called the filum ter- 
minale. The cord is a cylindrical structure, slightly flattened 
before and behind, and is considerably smaller than the canal, 
which allows movements of the vertebral column to take place 
without jarring the cord. 

The cord has three coverings continuous with those of tne 
farain viz., dura mater, arachnoid mater, and pia mater. The 
cord is suspended within the dura mater by two ligaments, which 
project laterally in its whole length, called the ligamenta dentic- 
ulata. These extend outwards, and are attached to the inner 
surface of the dura mater by tooth-like projections. 

The cord is not of uniform thickness throughout, but is con- 
siderably thickened in the lower cervical and upper lumbar 
regions. The cord similarly to the brain has a longitudinal fissure 
running down its posterior surface, which grooves it nearly to 
the centre. There is a shallower anterior furrow, and two very 
shallow grooves, one on each side of the posterior crus. These 
are called the postero-lateral grooves. 

On transverse section the cord is seen to consist also of grey 
and white matter, but the grey matter is entirely embedded in 
the white, and has a minute central canal running through 
it, which communicates above with one of the ventricles of 
the brain. The grey matter forms a column which extends 



176 HANDBOOK OF ANATOMY 

the whole length of the cord, and in transverse section re- 
sembles in shape the letter H, the four ends of which are called 
horns. 

There are thirty-one pairs of spinal nerves, which are attached 
by two roots each to the lateral aspects of the cord opposite the 
anterior and posterior horns of grey matter on each side respec- 
tively. These nerves come through the intervertebral foramina,, 
and are named according to the vertebrae below which they 
emerge, except in the case of the cervical ones. The first 
nerve comes out between the occipital bone and the atlas, so^ 
that there are eight pairs of cervical nerves, twelve pairs of 
dorsal nerves, five pairs of lumbar nerves, five pairs of sacral 
nerves, and one pair of coccygeal nerves. As the cord itself 
ends in the upper lumbar region, the lower nerves lie in the ver- 
tebral canal, forming what is known as the cauda equina, and 
emerging in order through the intervertebral foramina. 

The spinal nerves are attached to the cord by two roots 
anterior and posterior which join together inside the vertebral 
canal so that a mixed nerve i.e., formed by the junction of the 
two roots emerges from the intervertebral foramen. It im- 
mediately divides into anterior and posterior divisions. 

The posterior divisions supply the skin at the back of the 
head, neck, shoulder, buttock, and trunk, and the longitudinal 
muscles of the back. Each divides into two parts an internal 
and external trunk. In the upper half of the body the in- 
ternal trunks are cutaneous, the external ones muscular; in 
the lower half of the body the reverse is the case. The pos- 
terior divisions of the first and second cervical nerves vary a 
little. 

First cervical nerve (suboccipital) does not divide into internal 
and external'trunks, and gives off no cutaneous branches. Mus- 
cular branches to complexus, rectus capitis posticus major and 
minor, obliquus superior and inferior. 

Second cervical nerve (great occipital) supplies the skin at the 
back of the head as far as the vertex, and communicates with 
the other cutaneous nerves of that region. 

Muscular branches to complexus, obliquus inferior, and other 
muscles on the back of the neck. 



THORACIC NERVES 177 

Third cervical nerve is called the least occipital nerve, and 
is rather small, but its distribution is similar to that of the 
posterior divisions of the other spinal nerves. 

The anterior divisions of the rest supply the trunk and the 
limbs. They form what are called plexuses, which are groups 
of nerves joined up together. There are five plexuses viz. r 

Cervical plexus, formed by cervical nerves 1, 2, 3, and 4, 
supplies the muscles and skin of the neck. 

Brachial plexus, formed by cervical nerves 5, 6, 7, 8, and a 
branch of the first dorsal nerve, supplies the upper limb. 

Lumbar plexus, formed by a branch of the twelfth dorsal 
nerve, lumbar nerves 1, 2, 3, and a branch of the fourth lumbar 
nerve, supplies the anterior, inner, and outer surfaces of the 
thigh. 

Sacral plexus, formed by lumbar nerves 4 and 5, and sacral 
nerves 1, 2, 3, supplies buttock, posterior surface of thigh and 
leg and foot. 

Pudendal plexus, formed by a branch of the third sacral 
nerve, sacral nerves 4 and 5, and the coccygeal nerve, supplies 
the perineum. 

The anterior divisions of the twelve dorsal or thoracic nerves 
supply the skin and muscles on the anterior and lateral surfaces 
of the trunk. The first eleven are intercostal, the twelfth lies 
below the last rib. 

The Intercostal Nerves are much alike in their course 
and distribution, but some of them differ slightly from the 
others. 

A typical thoracic nerve enters the posterior end of the 
subcostal groove, and lies between the intercostal muscles. 
Coursing forwards, it pierces the internal intercostal muscle 
about the middle of the chest wall, and lies on the pleura. Near 
the middle line it pierces again the internal intercostal musck 
and the aponeurosis of the external intercostal, and supplies 
the skin over the front of the chest corresponding to the an- 
terior half of the space to which it belongs. 

Branches. Cutaneous, a lateral cutaneous branch is given off 
in the mid-axillary line to the skin over the space to which it 
belongs ; it divides into anterior and posterior branches. 

12 



178 



HANDBOOK OF ANATOMY 



Muscular, to the intercostal muscles. 

First thoracic nerve divides into two parts. The upper larger 
part passes over the neck of the first rib, enters the neck behind 
the subclavian artery , and joins with the other nerves forming 



Hypogastric Branch. 
of Jlio-hypogastric 




Intercosto-humeral 

- -Additional Intercostc 
humeral 



Lateral Cutaneous 
1 2th Thoracic 

Iliac Branch of Ilio- 
hypogastric 



FIG. 62. CUTANEOUS NERVES OF TRUNK. 



the brachial plexus. The lower part enters the subcostal groove 
and supplies the intercostal muscles, but as a rule has no 
cutaneous branches. 

Second thoracic nerve has the same course as a typical thoracic 
nerve, but the lateral cutaneous branch, called the intercosto- 



SYMPATHETIC SYSTEM 179 

humeral nerve, is of unusually large size. It crosses the axilla 
and supplies the skin of the armpit, and the inner side of 
the posterior surface of the arm as far as the elbow. 

Third thoracic nerve is a typical one, except that the pos- 
terior half of the lateral cutaneous branch also extends into 
the arm, and' supplies a small portion of the posterior surface 
of the root of the limb. 

Fourth, fifth, and sixth thoracic nerves are typical. 

Seventh, eighth, ninth, tenth, and eleventh thoracic nerves at 
the anterior ends of their intercostal spaces pierce the attach- 
ment of the diaphragm and the transversalis abdominis, and 
pass forwards between the latter and obliquus internus. " Their 
anterior ends become cutaneous by piercing the sheath of the 
rectus and the muscle itself. They supply the intercostal 
muscles of their own spaces and the abdominal muscles, and 
help to supply the diaphragm. Their cutaneous branches are 
similar to those of the typical nerves. 

Twelfth thoracic nerve passes downwards under psoas and 
then passes forwards, similarly to those just above it. It gives 
off a large lateral cutaneous branch, which, passing down 
between the abdominal muscles, becomes cutaneous just above 
the iliac crest, and supplies the skin of the buttock as far 
down as the great trochanter of the femur. 

The Sympathetic System. 

The sympathetic system consists of two long chains of 
ganglia lying one on each side of the vertebral column, ex- 
tending from the base of the skull to the coccyx. The ganglia 
:are connected to the spinal cord by white rami communicantes 
given off by some of the spinal nerves (second thoracic to 
second lumbar and three or four sacral) as they emerge from 
the inter vertebral foramina. The ganglia send grey rami com- 
municantes back to the cord. Above, the chain ends by a plexus 
of nerves sent into the cranial cavity on the internal carotid 
artery, and below, the two terminal ganglia communicate with 
one another. 

The ganglia send branches of supply to vessels, viscera, in- 
voluntary muscles, and glands. 



180 HANDBOOK OF ANATOMY 

In the cervical region there are only three ganglia on each 
side, but below this there is a ganglion on each side opposite 
each vertebra. 

The ganglia in the cervical and thoracic regions form plexuses 
on the vessels in their vicinity, and also form plexuses to supply 
the pharynx, larynx, heart, and lungs. In addition they com- 
municate with the lumbar ganglia by means of the splanchnic 
nerves, which pierce the diaphragm to join the solar plexus. 

The Splanchnic Nerves, three in number, are formed by 
branches from the fifth to the twelfth thoracic ganglia. 

The Solar Plexus consists of three parts the coeliac plexus- 
and the two semilunar ganglia. They lie behind the stomach,, 
on the aorta, just above the coeliac axis. They send out 
branches, which form subsidiary plexuses, accompanying the- 
branches of the artery to the various organs. 

The Aortic Plexus is the continuation on the front of the aorta 
of the solar plexus, and, like the latter, forms subsidiary plexuses 
on the branches of the vessel. 



SECTION XIV 
CERVICAL PLEXUS 

THE cervical plexus is formed by the anterior primary divisions 
of the first four cervical nerves. The nerves emerge from the 
intervertebral foramina behind the vertebral artery, and each 
nerve is joined at once by a communicating branch from the 
sympathetic ganglion. The plexus lies on the scalenus medius 
muscle, and is covered by sterno-mastoid. The four nerves join 
with another, forming a series of loops, from which the branches 
of distribution arise. 

Branches. (1) Cutaneous to head, neck, and shoulder. 

(2) Muscular to muscles of neck and diaphragm. 

(3) Communicating to vagus, spinal accessory, hypoglossal, 
and sympathetic. 

(1) The Cutaneous branches appear in the posterior triangle of 
the neck. The three ascending ones turn upwards over posterior 
border of sterno-mastoid, the three descending ones to the 
clavicular region. 

Ascending Branches : (a) Small occipital supplies skin on back 
of ear and on scalp over mastoid process. 

(b) Great auricular crosses sterno-mastoid obliquely upwards, 
and supplies the scalp behind the ear, the lower part of the 
pinna, and the skin over the lower part of the masseter and 
the parotid gland. 

(c) Superficial cervical crosses straight over the sterno-mastoid 
and supplies the skin over the anterior triangle of the neck. 

Descending Branches : One large trunk is formed whic 
descends from beneath sterno-mastoid. It extends through the 
posterior triangle of the neck and supplies . the skin over the 

181 



182 



HANDBOOK OF ANATOMY 



clavicle by dividing into three parts sternal, clavicular, and 
acromial. 

(2) The Muscular branches of the plexus are in two sets 
internal and external, according to their relation to the sterno- 
mastoid muscle. 

External branches passing outwards to posterior triangle 



Attrahens Auriculam 



Attollens Auriculam . 



Retrahens Auriculam 



Occipitalis- 
Great Occipital Nerve- 



Levator Anguli Scap 

Great Auricular Nerve .. 
Spinal Accessory Nerve .- 
Branches from Third and Fourtn 
Cervical Nerves to Trapezius 
Scalenus Mediu 

Supra-acromial Nerve 
Trapezius.. 




Small Occipital Nerve- - 
Splenius Capiti 



_.Frontalis 

] Oi bicularis Palpebrarum 

Levator Labii 
Superioris Alaeque Nasi 
.Levator Labii Superioris 
Zygomaticus Minor 
?^l.Zygomaticus Major 

Masseter 

. Orbicularis Oris 

..Depressor Labii Inferioris 
--Depressor Anguli Oris 
Levator Menti 

Anterior Belly of Digastric 

Sterno-hyoid 

'Anterior Belly of Omo-hyoid 

. Sterno-cleido-mastoid 

. Superficial Cervical Nerve 



..Suprasternal Nerve 
.JSupraclavicular Nerve 



Scalenus Anticus 

/ i 

Posterior Belly of Omo-hyoid bubclavian Artery (third part) 

FIG. 63. NERVES IN POSTERIOR TRIANGLE OB' NECK. 



supply sterno-mastoid, levator scapulse, trapezius and the 
scaleni, and communicate with the spinal accessory nerve. 

Internal branches passing inwards to anterior triangle supply 
the prevertebral muscles, genio-hyoid, and infrahyoid muscles, 



CERVICAL PLEXUS 



183 



and communicate with the vagus and hypoglossal. There is a 
special branch to the diaphragm called the phrenic nerve. 

The Phrenic nerve is formed by branches from the third, 
fourth, and fifth cervical nerves. It passes down on scalenus 
anticus, and enters the thorax between the subclavian artery and 



Socia Parotidis 
Stensen's Duct 

Parotid Gland 



Transverse Facial Artery i 




Mental Artery 



Facial Artery 
Lingual Artery 

External Carotid Artery.. 
Superior Laryngeal Artery 
Superior Thyroid Artery.^ 

Pneumogasti 
Internal Jug 

Common Carotid Artery.. 1 
Anterior Belly of Omo-hyoid...\ .JIj]? 
Ascending Cervical Artery... 

Inferior Thyroid Artery,.. 



..Superficial Temporal Artery 
^. Internal Maxillary Artery 

Posterior Auricular 

Artery 

^Occipital Artery 

i. Great Occipital 

Nerve 

Internal Carotid 
Artery 



-^Deep Cervical 

Glands 

-- Phrenic Nerve 



Scalenus Anticus 

Muscle 

Transverse Cervical 
Artery 



Subclavian Artery (first part) \ "^ 

\ % Suprascapular Artery 

Thyroid Axis 

FIG. 64. VESSELS AND NERVES IN NECK. 



vein. 



It reaches the diaphragm by passing between the peri- 
cardium and pleura in front of the root of the lung. The nerve 
gives off some branches to the upper surface of the diaphragm, 
then pierces the muscle and supplies the under surface. It also 
gives off pleural, pericardial, and hepatic branches. 



SECTION XV 
BRACHIAL PLEXUS AND NERVES OF UPPER LIMB 

THE Braehial Plexus is formed by the anterior division of the 
fifth, sixth, seventh, and eighth cervical nerves, and the greater 
part of the first thoracic nerve. The second thoracic nerve, 

To Cervical Plexus 
To Braehial Plexus, 

Third Root of Phrenic (inconstant) 
Nerve to the Rhomboids 
Nerve to Subclavius 

' **/* *a\,Ajt/uiai. 

^ 

External Anterior Thoracic 

Circumflex 
Musculo-spiral \ 
Outer Root of Median 

Musculo-cutaneous 



Median 




* Posterior Thoracic (Ext. 
Respiratory N. of Bell). 
First Intercostal 



\ 



\ " Upper or Short Subscapular 
\ 'Internal Anterior Thoracic 
\ Middle or Long Subscapular 
\ \ Lower Subscapular 

X N Nerve of Wrisberg 

N Inner Root of Median 
Internal Cutaneous 



Ulnar 

FIG. 65. THE BRACHIAL PLEXUS. 

although not part of the plexus, helps in the innervation of the 
arm through the intercosto-humeral nerve. 

The nerves forming the plexus appear in the posterior triangle 

184 



BRACHIAL PLEXUS 185 

of the neck, and, passing between scalenus medius and aiiticus 
with the subclavian artery, they accompany the axillary artery 
to the shoulder and upper limb. 

As the nerves enter the posterior triangle they form the three 
primary cords 

First primary cord : Fifth and sixth nerves joined together. 

Second primary cord : Seventh nerve alone. 

Third primary cord : Eighth cervical and first thoracic joined 
together. 

As soon as the three cords are formed they each divide into 
anterior and posterior divisions to form the secondary cords, 
which are named according to their relation to the axillary 
artery. 

Outer cord : Anterior divisions of first and second primary 
cords. 

Inner cord : Anterior division of third primary cord. 

Posterior cord : Posterior divisions of all three primary cords. 

The nerves supplying the shoulder and arm are derived from 
these three cords viz. : 

Outer cord : Musculo-cutaneous, outer head of median, external 
anterior thoracic nerves. 

Inner cord : Ulnar, inner head of median, internal anterior 
thoracic, internal cutaneous, and lesser internal cutaneous nerves. 

Posterior cord : Circumflex, three subscapular and musculo- 
spiral nerves. 

Before the nerves join up to form the cords, a few branches 
are given off which are called Supraclavicular nerves to dis- 
tinguish them from the branches derived from -the secondary 
cords which are called the Infraclavicular nerves. 

Supraelavieular Nerves. Muscular branches to scaleni, sub- 
clavius, and longus colli. 

Posterior scapular supplies the rhomboids and levator anguli 
scapulas. 

Long thoracic supplies serratus magnus. It pierces scalenus 
medius and enters the axilla between the artery and serratus 
magnus. This nerve is also called the respiratory nerve of Bell. 

Suprascapular supplies supra- and infraspinatus and articular 
branches to the shoulder-joint. It passes down to the superior 



186 HANDBOOK OF ANATOMY 

border of the scapula, then through the suprascapular foramen 
and winds round the great scapular notch. 

Infraelavieular Nerves. The anterior set from the inner and 
outer cords supply the chest and front of the limbs, the posterior 
set of nerves from the posterior cord supply the shoulder and 
the back of the limb. 

Anterior Thoracic Nerves. The external anterior thoracic 
nerve arises from the outer cord, and the internal one from the 
inner cord. They pass down one on each side of the axillary 
artery, and are finally distributed to pectoralis major and 
minor. 

Museulo-Cutaneous nerve from the outer cord lies first 
between coraco-brachialis and the axillary artery; it then lies 
between biceps and brachialis to the bend of the elbow. It 
becomes cutaneous between biceps and brachio-radialis, and 
ends by supplying the skin on the outer side of the forearm. 

Branches. Muscular to biceps, brachialis anticus and coraco- 
brachialis (this last nerve is not really a branch of musculo- 
cutaneous, but is an independent branch from the sixth and 
seventh cervical nerves incorporated with it). 

Cutaneous. Anterior branch supplies the outer half of the 
anterior surface of the forearm as far as the ball of the thumb. 
The posterior branch supplies the upper three-fourths of the 
outer half of the posterior surface of the forearm. 

Median nerve arises by two roots one from the outer cord 
and one from the inner. The outer head passes down on the 
outer side of the axillary artery, and the inner head crosses over 
at the beginning of the brachial artery to join it. The complete 
nerve then passes down on the outer side of the brachial artery,, 
and crosses over it to the inner side, at the level of the inferior 
profunda branch about the middle of the arm. At the elbow it 
lies on the inner side of the artery beneath the bicipital fascia 
and the median basilic vein, and passes into the forearm between 
the two heads of pronator radii teres, the deep head of which 
separates the nerve from the ulnar artery. The nerve then 
passes down the forearm between the superficial and deep 
muscles, and enters the palm of the hand beneath the anterior 
annular ligament on the outer side of the flexor tendons. In the 



MEDIAN NERVE 



187 



hand it lies beneath the palmar fascia and superficial palmar arch, 
and divides into its six terminal branches. 

Branches. There are none in the upper arm. 

In the forearm: 1. Articular to the elbow-joint. 

2. Muscular to pronator radii teres, palmaris longus, flexor 
carpi radialis, flexor sublimis digitorum, flexor longus pollicis, 
and flexor profundus digitorum. 

Supra-acromial 



-Cutaneous Branch of 
Circumflex 

-Internal Cutaneous of 

Musculo spiral 
- 1 ntercosto -humeral 

Lower External Cutaneous 
of Musculo-spiral 

Nerve of Wrisberg 



Posterior Branch of Internal 
Cutaneous 

Posterior Branch of Musculo- 
cutaneous 



Radial 

-Dorsal Branch of Ulnar 



FIG. 66. CUTANEOUS NERVES OF UPPER LIMB (POSTERIOR SURFACE). 

3. Anterior Interosseous passes down the anterior surface of 
interosseous membrane with the artery of the same name and 
beneath the pronator quadratus. It terminates by supplying the 
wrist-joint, and in its course supplies flexor longus pollicis, outer 



188 



HANDBOOK OF ANATOMY 



half of flexor prof undus digitorum, pronator quadratus, and twigs 
to the bones, periosteum, and interosseous membrane. 

4. Palmar Cutaneous branch (not always present) arises in the 
lower third of the forearm, pierces the deep fascia, and supplies 
the skin of the palm. 



Supraclavicular 

Anterior Branches of Lateral Cutaneous 
Supra-acrouiial ', 



Suprasternal 



Cutaneous Branch of 
Circumflex 



Upper External Cutaneous, 
of Musculo-spiral 



Branch of Radial 




Anterior Cutaneous 



~" ' Twi "s: of Internal Cutaneous 
x -~ Tntercosto-humeral 



...Anterior Branch of Internal Cutaneous 
.._. Posterior Branch of Internal Cutaneous 
---- Anterior Branch of Musculo-cutaneous 



[ Twig of Ulnar 

(occasional) 



^._- Palmar Cutaneous of Ulnar 
Palmar Cutaneous of Median 



FIG. 67. CUTANEOUS NERVES OF UPPER LIMB (ANTERIOR SURFACE). 

In the hand : 1 . Muscular to abductor pollicis, opponens 
pollicis, superficial head of flexor brevis pollicis, and the two 
lumbricales on the radial side. 

2. Cutaneous to the skin of the thumb, the first and second 
fingers, and the radial half of the third finger. These nerves 



ULNAE NERVE 189 

turn over the tops of the fingers and supply the posterior surface 
of the terminal phalanges. 

Ulnar nerve arises from the inner cord of the brachial plexus. 
It lies between the axillary artery and vein, and passes down on 
the inner side of the brachial artery in front of triceps. In the 
lower half of the arm it passes behind the internal intermuscular 
septum with the inferior profunda artery lying anterior to the 
inner head of triceps, and reaches the interval between the 
internal condyle of the humerus and the olecranon process. It 
enters the forearm between the two heads of flexor carpi ulnaris 
and passes down between it and flexor profundus digitorum on 
the inner side of the ulnar artery. It passes into the hand over 
the anterior annular ligament on the radial side of the pisiform 
bone, and divides beneath palmaris brevis into its terminal 
branches. 

Branches. There are none in the upper arm. 

In the forearm : Articular to the elbow-joint. 

Muscular to flexor carpi ulnaris and the inner half of flexor 
profundus digitorum. 

Cutaneous. Palmar supplies the skin over the ulnar side of 
the wrist, the hypothenar eminence, and ulnar side of palm. 
Dorsal supplies the skin on the ulnar side posterior surface of 
wrist and hand, the little finger and ulnar side of third finger. 

In the hand : Muscular to palmaris brevis. It then divides 
into terminal branches superficial and deep. 

Superficial. Cutaneous to anterior surface of little finger and 
ulnar side of third finger. 

Deep. Muscular to all the muscles of the hand except those 
supplied by the median nerve. 

Internal Cutaneous nerve arises from the inner cord of the 
brachial plexus. In the upper part of its course it lies super- 
ficial to the artery and the ulnar nerve. It then pierces the 
deep fascia about the middle of the inner side of the arm, and 
accompanies the basilic vein to the elbow, where it divides into- 
its two terminal branches. 

Branches. In the upper arm a branch which supplies the 
lower half of the anterior surface on its inner side. 

In the forearm there are two branches one supplies the 



190 HANDBOOK OF ANATOMY 

anterior surface of the inner side of the forearm as far as the 
wrist, the other supplies the upper three-fourths of the posterior 
surface of the inner side. 

Lesser Internal Cutaneous arises from the inner cord of the 
brachial plexus. It supplies the skin of the upper half of the 
arm on the inner side. 

Circumflex nerve' from the posterior cord passes down behind 
the axillary artery and goes through the quadrilateral space in 
company with the posterior circumflex artery. It winds round 
the surgical neck of the humerus and ends in the deltoid (see 
Fig. 6). 

Branches. Muscular to the teres minor and deltoid muscles. 

Articular to the shoulder- joint. 

Cutaneous to the skin over the deltoid and upper half of the 
arm. 

The Musculo-Spiral nerve is the continuation of the posterior 
cord of the brachial plexus. It passes through the axilla behind 
the axillary artery, and down the arm behind the brachial artery 
on the long head of triceps. It then courses downwards and 
outwards in the musculo-spiral groove with the superior pro- 
funda artery, separating the heads of the triceps. The nerve 
then pierces the external intermuscular septum, and lies in 
front of the external condyle of the humerus between brachialis 
anticus and supinator longus, where it ends by dividing into the 
radial and posterior inter osseous nerves. 

Branches. On the inner side of the humerus : 

1. Internal Cutaneous supplies the skin of the upper third of 
the inner side of the arm. 

2. Muscular to the three heads of triceps. 
At the back of the humerus : 

Muscular to the three heads of triceps and anconeus. 

On the outer side of the humerus : 

1. Cutaneous. A superior branch supplies the skin on the 
outer side and back of the lower third of the arm and the upper 
half of the back of the forearm. An inferior branch supplies 
the skin in the upper two-thirds of the back of the forearm on 
the inner side of the area supplied by the musculo- cutaneous 
nerve. 






MUSCULO-SPIEAL NERVE 191 

2. Muscular to brachialis anticus, supinator longus, and 
extensor carpi radialis longior. 

3. Radial nerve passes down the upper two-thirds of the 
forearm external to the radial artery and covered by supinator 
longus. It pierces the deep fascia on the outer side of the lower 
third of the forearm, and passes to the back of the wrist. It 
supplies the skin on the back of the wrist, the radial side of the 
back of the hand and the back of the thumb, first and second 
fingers, and radial side of the third finger as far as the second 
phalanges, the rest being supplied by the median nerve. 

4. Posterior Interosseous nerve is entirely muscular and articu- 
lar in its distribution. It reaches the back of the forearm by 
passing from under supinator longus round the outer side of the 
radius, and pierces supinator brevis. On the back of the forearm 
it passes beneath the extensor muscles with the posterior inter- 
osseous artery, then gets on the interosseous membrane by 
passing beneath extensor longus pollicis, and terminates in a 
gangliform enlargement on the back of the wrist. 

Branches. Articular to the carpal joints. 

Muscular to extensor carpi radialis brevis, supinator brevis, 
and all the extensor muscles on the back of the forearm. 

Subseapular Nerves. There are three subscapular nerves 
arising from the posterior cord of the brachial plexus. They 
all pass down behind the axillary artery, and are all purely 
muscular : 

First or short subscapular nerve to subscapularis. 

Second or lower subscapular nerve to teres major. 

Third or long subscapular nerve to latissimus dorsi. 



SECTION XVI 

LUMBAR AND SACRAL PLEXUS AND NERVES OF 
LOWER LIMB 

THE anterior divisions of the remaining spinal nerves viz., five 
lumbar, five sacral, and one coccygeal form the lumbo-sacral 
plexus, which supplies the lower part of the trunk and the lower 
limb. For convenience of description the plexus is divided into 
three parts lumbar, sacral or sciatic, and pudendal. 

The lumbar plexus is formed by the first four lumbar nerves 
and a branch of the twelfth thoracic. 

The sacral or sciatic plexus is formed by part of the fourth 
lumbar, the fifth lumbar, and the first three sacral nerves. 

The pudendal plexus is formed by branches from the second 
and third sacral nerves, the fourth and fifth sacral nerves, and 
the coccygeal nerve. This plexus supplies mainly the perineum. 

The Lumbar Plexus is formed by the anterior divisions of the 
first three lumbar nerves, a part of the fourth, and a small 
branch from the twelfth thoracic nerve. It is placed deeply in 
the substance of psoas just in front of the transverse processes 
of the lumbar vertebrae. On emerging from the intervertebral 
foramina, and after communicating with the sympathetic system, 
the nerves divide to form the plexus. 

The first and second nerves divide into upper and lower parts. 
The upper part of the first nerve joins with the branch from the 
twelfth thoracic and forms the ilio-inguinal and ilio-hypogastric 
nerves. The lower part of the first nerve and the upper part of 
the second join to form the genito-crural nerve. The lower part 
of the second nerve, the third nerve, and the upper part of 
the fourth nerve divide into anterior and posterior parts. The 
anterior parts join to form the obturator nerve, and the posterior 
parts form the anterior crural nerve ; from the posterior parts of 

192 



ILIO-HYPOGASTRIC NERVE 



193 



the second and third nerves,, branches are given off, which join 
to form the external cutaneous nerve. Before these divisions 
take place branches are given off from the lumbar nerves to 
supply quadratus lumborum and psoas. 

Ilio-Hypogfastrie Nerve, formed by the branch from th* 
twelfth thoracic nerve and the upper part of the first lumbar 
nerve. It emerges from psoas, and passes between the trans- 



I2.T. 



DORS.LUMB.N. 




'----._ Lumbo-sacral Cord 



FIG. 68. LUMBAR PLEXUS. 

versalis and obliquus internus muscles above the crest of tho 
ilium, and becomes cutaneous in the lower part of the anterior 
abdominal wall. 

Branches. Muscular to abdominal muscles. 

Cutaneous. Iliac branch which corresponds to the lateral 
cutaneous branches of the thoracic nerves, and supplies the skin 
over the upper part of the buttock. Hypogastric branch, which 
supplies the skin over the pubis. 

13 



194 HANDBOOK OF ANATOMY 

Ilio-Inguinal nerve in origin and course resembles the ilio- 
hypogastric nerve, but pierces the abdominal wall lower down,, 
and becomes cutaneous by passing through the external abdom- 
inal ring and spermatic fascia. 

Branches. Muscular to the abdominal wall. 

Cutaneous to skin over the symphysis pubis, the upper and 
inner part of Scarpa's triangle, and the upper part of the 
external genital organs. 

Genito-Crural nerve arises from the first and second lumbar 
nerves, which unite in the substance of psoas. The nerve 
passes down on the outer side of the external iliac vessels and 
becomes cutaneous just above Poupart's ligament, and supplies 
the skin over Scarpa's triangle, external to the ilio-inguinal 
nerve. A small branch passes upwards to the external genital 
organs. 

External Cutaneous nerve arises from the second and third 
lumbar nerves. The nerve crosses the iliacus muscle to the 
anterior superior spine of the ilium. It then pierces the origin 
of sartorius, and becomes cutaneous a few inches below this 
point, where it divides into anterior and posterior terminal 
branches. 

Branches. Anterior supplies the skin on the outer side of the 
front of the thigh almost to the knee. 

Posterior supplies the skin on the outer side of the buttock 
below the great trochanter and the skin of the upper two-thirds 
of the outer side of the thigh. 

Obturator nerve arises from the second, third, and fourth 
lumbar nerves. The nerve emerges from the inner border of 
psoas behind the common iliac vessels. It passes forwards with 
the obturator artery, and goes through the groove in the thyroid 
foramen, where it divides into two branches superficial and 
deep. This nerve supplies the muscles and skin on the inner 
side of the thigh. 

The Superficial part of the obturator nerve enters the thigh 
beneath pectineus, and, passing down the inner border of 
adductor longus, anterior to gracilis, it finally divides into two 
terminal branches, one of which enters Hunter's canal. 

Branches. Articular to the hip-joint. 



ANTERIOR CRURAL NERVE 195 

Muscular to adductor longus, gracilis, adductor brevis, and 
pectineus (occasionally) . 

Cutaneous becomes superficial in the middle third of the thigh, 
and supplies skin of the lower two-thirds of the inner side of the 
thigh, and ends in the subsartorial plexus. The terminal branch, 
which enters Hunter's canal, ramifies over the femoral artery. 

The Deep part of the obturator nerve pierces obturator ex- 
ternus and passes down between adductor brevis and adductor 
magnns ; it then passes through adductor magnus, and, entering 
the popliteal space, terminates by supplying the knee-joint. 

Branches. Muscular to obturator externus, adductor magnus 
and adductor brevis (if not already supplied by the superficial 
part) . 

Articular to the knee-joint. 

The Anterior Crural nerve arises from the second, third, and 
fourth lumbar nerves behind the obturator nerve. It is formed 
in the substance of psoas, and, emerging from its outer border, 
it passes down between psoas and iliacus, and enters the 
thigh by passing under Poupart's ligament on the outer side of 
the femoral vessels. In Scarpa's triangle it breaks up into 
branches to supply the front of the thigh. 

Branches. In the abdomen : Muscular to iliacus. 

In Scarpa's triangle : Muscular to pectineus, sartorius, and 
quadriceps extensor. 

Articular to the hip and knee joints. 

Cutaneous. The cutaneous branches are in three sets middle 
and internal cutaneous and long saphenous. 

Middle Cutaneous nerve arises in two parts the external and 
internal. They supply the skin on the lower three-fourths 
of the front of the thigh, and end in the patellar plexus. 

Internal Cutaneous nerve lies in Scarpa's triangle on the 
outer side of the femoral vessels, over which it crosses, and, 
dividing into three branches, all of which terminate in the 
patellar plexus, supplies the skin on the lower two-thirds of the 
inner side of the thigh. 

The Long Saphenous nerve arises in Scarpa's triangle. It 
passes down with the femoral vessels through Hunter's canal, at 
the lower end of which it crosses over the tendon of adductor 



196 



HANDBOOK OF ANATOMY 



ma'gnus and becomes cutaneous on the inner side of the knee- 
joint by passing between sartor ius and gracilis. It passes down 
the inner side of the leg with the internal saphenous vein, and 
supplies the skin of the front and inner side of the leg and 
posterior half of the dorsum and inner side of the foot. 

The Patellar Plexus is formed by the branches of the 
cutaneous nerves supplying the skin in front of the knee viz., 



To Lumbar Plexus 




Perforating Cutaneous 



To CoccygeaJ Plexus 



Pudic 

FIG. 69. SACRAL PLEXUS. 



B 



1, i, i. Nerve to Quadratus Femoris 

2, 2, 2. Nerve to Obturator Internus 

3, 3, 3. Small Sciatic Nerve 



4 S. Fourth Sacral, giving a Branch to 
Sacral Plexus 

V. Visceral Branches 

M. Muscular Branches 
T.C. Terminal Cutaneous Branches 



the long saphenous, internal and middle cutaneous, all branches 
of the anterior crural nerve, and sometimes a branch of the 
external cutaneous nerve. 

The Sacral OP Sciatic Plexus is formed by the anterior divi- 
sions of the fourth and fifth lumbar nerves and the first three 
sacral nerves. The plexus is formed on the anterior surface of 
pyriformis, all the nerves joining to form a large triangular trunk 



SCIATIC PLEXUS 197 

which passes through the sacro -sciatic foramen as the great 
sciatic nerve, which supplies the back of the thigh and the 
whole of the leg and foot (excepting that part of skin supplied 
by the saphenous nerve) ; small branches arise from the anterior 
and posterior surfaces of the plexus to supply the parts in the 
vicinity. The great sciatic nerve ends at the popliteal space By 
dividing into tibial and peroneal nerves (internal and external 
popliteal nerves). In reality this division can be traced all the 
way up to the plexus, so that the nerve is really constituted in 
two parts, but for purposes of description it is easier to call the 
upper part one trunk namely, the great sciatic. 

The plexus is formed by the lower part of the fourth lumbar 
nerve joining the fifth lumbar nerve, which, known as the lumbo- 
sacral cord, passes into the pelvis over the sacro-iliac articulation, 
and on pyriformis joins the first and second and upper part of 
third sacral nerves. The three sacral nerves also send branches 
to the pudendal plexus, so that no distinct line can be drawn 
between them. 

Branches from the plexus (other than great sciatic) : 

Anterior. Muscular to quadratus femoris, obturator internus 
and gemelli. 

Articular to hip- joint. 

Posterior. Muscular to pyriformis and glutei (superior and 
inferior gluteal nerves). 

Articular to knee-joint (via the nerve to biceps) . 

Cutaneous to skin on back of thigh (small sciatic). 

Superior Gluteal nerve arises from the fourth and fifth 
lumbar and the first sacral nerves. It passes through the 
sacro-sciatic foramen, with the gluteal artery above pyriformis, 
and supplies gluteus medius and minimus and tensor fasciae 
femoris. 

Inferior Gluteal nerve arises from the fifth lumbar and first 
and second sacral nerves. It passes through the sacro-sciatic 
foramen beneath pyriformis, and supplies gluteus niaximus. 

Small Sciatic nerve passes through the sacro-sciatic foramen 
below pyriformis, with the sciatic artery and inferior gluteal 
nerve. It enters the thigh at the lower border of gluteus maxi- 
nius, and, piercing the deep fascia, it supplies the skin on the 



198 HANDBOOK OF ANATOMY 

tack of the thigh and over the calf of the leg. It is a purely 
cutaneous nerve. 

Branches. Perineal arises at the lower border of gluteus 
maximus, and, passing inwards, supplies the skin over the peri- 
neum and external genital organs. 

Gluteal arise beneath gluteus maximus, and, passing round its 
lower border, supply the skin over the lower half of the 
buttock. 

Femoral in two sets internal and external supply the skin 
on the back of the thigh. 

Sural. Two or more branches which pierce the fascia over 
the popliteal space and supply the skin over the calf of the leg 
for a variable distance. 

The Great Sciatic nerve passes through the sacro-sciatic 
foramen below pyriformis between it and the superior gemellus. 
Covered by gluteus maximus, it passes down, into the thigh, 
accompanied by the sciatic artery and a special artery of its own 
(arteria comes nervi ischiadici) . It lies in the hollow between 
the great trochanter and the tuberosity of the ischium, and enters 
the thigh beneath the lower border of gluteus maximus. Lying 
between it and the origin of the hamstrings, it is comparatively 
superficial. In the thigh it lies on adductor magnus, and is 
covered by the hamstrings, and at a variable point between 
the sacro-sciatic foramen and the upper part of the pop- 
liteal space divides into the internal and external popliteal 
nerves. 

Branches. Muscular to the hamstrings and short head of 
biceps. 

Articular to the knee-joint. 

The External Popliteal Nerve. One of the terminal branches 
of the great sciatic nerve passes beneath the tendon of biceps 
obliquely through the upper and outer part of the popliteal 
space ; it then passes over the outer head of gastrocnemius, and 
just below the head of the fibula divides into its terminal 
branches, the anterior tibial and musculo-cutaneous nerves. 

Branches. Cutaneous to the skin over the calf of the leg. 
Peroneal communicating joins a similar bra'nch from the tibial 
nerve to form the short saphenous nerve. 



INTERNAL POPLITEAL NERVE 199 

Muscular. Recurrent tibial, which, passing forwards, supplies 
tibialis anticus (upper fibres). 

Articular. Branches to the knee-joint and tibio-fibular articu- 
lation from the recurrent tibial. 

The Anterior Tibial nerve passes beneath peroneus longus 
and the extensors of the toes to the front of the leg. With the 
anterior tibial artery it lies on the interosseous membrane and 
the lower part of the tibia. Passing beneath the anterior 
annular ligament, it divides on the dorsum of the foot into its 
terminal branches. 

Branches. Muscular to tibialis anticus, extensor proprius 
liallucis, extensor longus digitorum and peroneus tertius, and 
extensor brevis digitorum (from its external terminal branch). 

Articular to ankle-joint and tarsal and metatarsal joints 
(from its external terminal branch). 

Cutaneous from the internal terminal branches. The nerve 
passes along the dorsum of the foot on the outer side of the 
dorsalis pedis artery and supplies the skin of the cleft, between 
the first and second toes. 

The Musculo- Cutaneous nerve passes down the leg, lying 
between the peronei and the extensor muscles. In the lower 
third of the leg it pierces the deep fascia and divides into its 
two terminal branches internal and external. 

Branches. Muscular to peroneus longus and brevis. 

Cutaneous to the lower third of the skin of the leg, and, passing 
over the anterior annular ligament, to the dorsum of the foot, the 
inner side of the great toe and the skin of the clefts between the 
toes, not excepting the one also supplied by the anterior tibial 
nerve. 

The Internal Popliteal Nerve. One of the terminal branches 
of the great sciatic nerve, from the upper part of the popliteal 
space to the lower border of the popliteus muscle, where it is 
continued down the leg. It lies at first beneath semimem- 
branosus; then, crossing the popliteal vessels to their inner 
side, it lies on popliteus and is covered by gastrocnemius 
and plantaris. It then passes down the back of the leg 
between the superficial and deep muscles with the posterior 
tibial vessels, at first on their inner side, but crossing over in the 



200 



HANDBOOK OF ANATOMY 



middle of the leg the nerve lies on their outer side in the lower 
half. It divides into its terminal branches, the internal and 



Gluteus Medius 



Gluteus Maximus 



Biceps - 
Semitendinosus - 

Senjimembranosus 

Crureus 

Gracilis 

Internal Popliteal Nerve 
Sartorius ....... 



Gastrocnemius 




Ilio-hypogastric Nerve 

Lateral Cutaneous of 

i2th Thoracic Nerve 

Posterior Divisions of 

first three Lumbar 

Nerves 

Posterior Divisions of 
Sacral Nerves 

Post. Div. of Cocc. N. 

Perforating Cutan. N^ 
Gluteal Branches of 
Small Sciatic Nerve 
Post. Branch of Ext. 
Cutaneous Nerve 



Small Sciatic Nerve 

(Outline) 

r~ -----Femoral Branches of 
Small Sciatic Nerve 



;:-Ext. Cutaneous N. 
(Anterior Branch) 



' Small Sciatic Nerve 



Posterior Branch of Int. 

Cutaneous Nerve 
Lateral Cutaneous of 
External Popliteal 
Nerve 



Ramus Commun..Fib. 
Ramus Commun. Tib. 



Ext. Saphenous Nerve 

Branches of Internal 
Saphenous Nerve 



Soleus{ ~_~^1"; 

Flexor Longus 

Digitorum ...... 

Peroneus Longus 
Tendo Achillis 

Tibialis Posticus 
Plantaris ._ 



FIG. 70. MUSCLES AND CUTANEOUS NERVES OF LEG (POSTERIOR VIEW). 



external plantar nerves, beneath the internal annular liga- 
ment. 



INTERNAL POPLITEAL NERVE 



201 



Branches. In the popliteal space : 

Muscular to gastrocneniius, plantar is, soleus, and popliteus. 

Obliquus Externus Abdominis Ext. Abdominal Ring 



Giuteus Medius 



Iliacus 

Tensor Fasciae Femoris 

Psoas Magnus 

Pectineus 

Sartorius 

Adductor Longus 
Gracilis 

Rectus Femoris 
Ilio-tibial Band 

Vastus Externus- 
Vastus Internus- 



Ligamentum Patellae *- 



Gastrocnemius 



Peroneus Longus 
Soleus 

Kxt. Longus Digitorum 



Ext. Proprius Hallucis 

Tibialis Antirus 

Peroneus Tertiu. 

Anterior Annular 

Ligament 




. Ext. Cutaneous Nerve 

Crural Branch of Genito- 

crural Nerve 
Inguinal Nerve 

Saphenous Opening 
_--. Mid. Cutaneous Nerve 



Int. Saphenous Vein 

^..4 Int. Cutaneous Nerve 

(Outline) 



Ant. Branch of Internal 

Cutaneous Nerve 



-- Patellar Plexus of Nerves 
_.._ Patellar Branch of Internal 

Saphenous Nerve 
- Int. Saphenous Nerve 

Int. Saphenous Vein 
... Post. Branch of Internal 
Cutaneous Nerve 



Cutaneous Part of Musculo- 

cutaneous Nerve 
' Calcaneo-plantar Nerve 

Int. Saphenous Nerve 

(Terminal Part) 



FIG. 71. MUSCLES AND CUTANEOUS NERVES OF LEG (ANTERIOR VIEW). 

The latter nerve winds round the lower border of the muscle 
and enters its deep surface, giving off a branch to tibialis 
posticus. 



202 HANDBOOK OF ANATOMY 

Articular. Several to knee-joint, and one to the upper tibio- 
fibular joint, and to tar sal and metatarsal joints through the 
short saphenous nerve. 

Cutaneous. The tibial communicating, pierces the deep fascia 
in the middle third of the leg, where it is joined by the peroneal 
communicating, to form the short saphenous nerve which supplies 
the skin on the back of the leg, and, passing behind the external 
malleolus, supplies the ankle and heel and outer side of the foot 
and little toe. 

In the back of the leg: 

Muscular to soleus, tibialis posticus, flexor longus hallucis and 
flexor longus digitorum. 

Cutaneous to the skin of the heel and the posterior part of 
the sole of the foot by a branch called the internal calcanean. 

Internal Plantar Nerve. A terminal branch of the posterior 
tibial nerve arises beneath the internal annular ligament, and 
passes forwards between abductor hallucis and flexor brevis 
digitorum with the internal plantar artery. 

Branches. Muscular to abductor hallucis, flexor brevis digit- 
orum, flexor brevis hallucis, and first lumbrical. 

Articular to inner tarsal and metatarsal joints. 

Cutaneous to the inner half of the sole of the foot and the 
three and a half toes on the inner side. 

The External Plantar Nerve, one of the two terminal 
branches of the posterior tibial nerve, arises beneath the internal 
annular ligament, and passes outwards with the external plantar 
artery between flexor brevis digitorum and accessorius. 

Branches. Muscular to all the muscles in the sole of the foot 
except those supplied by the internal plantar nerve ; the inter- 
ossei, and three lumbricals on the outer side. 

Articular to the tarsal and metatarsal joints. 

Cutaneous to the skin of the outer half of the sole of the foot 
and the one and a half toes on the lateral side. 

The Pudendal Plexus is formed by branches from the anterior 
division of the first three sacral nerves, of the fourth and fifth 
sacral nerves, and the coccygeal nerves. It is formed on the 
back wall of the pelvis, and is distributed to the perineum 
{mainly by the pudic nerve) except for a few visceral branches. 



PUDIC NERVE 203 

Branches. From the plexus : 

Muscular to levator ani, coccygeus, and external sphincter. 

Cutaneous to the lower part of the buttock by means of a 
branch called the perforating cutaneous nerve. 

The Pudic nerve arises from the second, third, and fourth 
sacral nerves ; it passes through the sacro-sciatic foramen, and 
lies on the spine of the ischium on the inner side of the internal 
pudic artery. It then enters the perineum with the artery 
through the small sacro-sciatic foramen. The nerve supplies 
all the muscles and skin of the perineum. 



SECTION XVII 
CRANIAL NERVES 

THERE are twelve pairs of cranial nerves emerging on each 
side of the base of the brain, which supply the tissues of the 
head and neck (see Fig. 61). 



Name of Nerve. 


Function. 


Exit from Brain. 


Distribution. 


1. Olfactory 


Sensory 


Olfactory bulb 


To mucous membrane of nose 


2. Optic 


Sensory 


Optic thalamus 


To eyeball 


3. Oculo -motor 


Motor 


Crus cerebri 


To muscles of eyeball 


4. Trochlear 


Motor 


Superior medul- 
lary velum 


To muscle of eyeball 


5. Trigeminal 


Mixed 


Pons varolii 


Sensory to face, tongue, and 
teeth ; motor to muscles of 
mastication 


6. Abducent 


Motor 


Junction of pons 
and medulla 


To muscle of eyeball 


7. Facial 


Mixed 


Pons varolii 


Motor to muscles of scalp and 
face ; sensory to tongue 


8. Auditory 


Sensory 


Pons varolii 


To internal ear 


9. Glosso- 
pharyngeal 


Sensory 


Medulla 


To tongue and pharynx 


10. Pneumogas- 
tric or vagus 


Sensory 


Medulla 


To pharynx, oesophagus, stomach, 
and respiratory organs 


11. Spinal acces- 
sory 


Mixed 


Medulla 


Accessory to vagus ; motor to 
trapezius and sterno-mastoid 


12. Hypoglossal 


Motor 


Medulla 


To muscles of tongue 



above table shows briefly the essential points as to the 
functions and distributions of the nerves, but some of them must 
be described in fuller detail. 

204 



TRIGEMINAL NERVE 205 

5. The Trig-eminal nerve arises from the outer surface of the 
pons varolii, and passes forward on the base of the skull to the 
apex of the petrous portion of the temporal bone. There it 
divides into three trunks : 

(1) Ophthalmic entirely sensory. 

(2) Superior maxillary entirely sensory. 

(3) Inferior maxillary sensory and motor. 

(1) The Ophthalmic division passes through the sphenoidal 
fissure and divides into three branches (a) lachrymal, (6) 
frontal, and (c) nasal. The lachrymal nerve passes along the 
outer side of the orbit and supplies the lachrymal gland, the 
conjunctiva and skin of the outer corner of the eye. The 

frontal nerve passes forwards in the upper part of the orbit, 
and divides into the supraorbital and supratrochlear nerves, 
which pass through the supraorbital notch and inner corner 
of the eye respectively, and supply the skin of the forehead 
and scalp, the supraorbital nerve reaching as far back as the 
vertex. The nasal nerve enters the nose to supply the mucous 
membrane, and sends an external branch to supply the skin of 
the lower part of the nose. 

(2) The Superior Maxillary division passes through the fora- 
men rotundum in the root of the pterygoid process, passes 
through the orbit, and emerges on the face through the infra- 
orbital foramen. Before reaching the face the nerve gives off 
three dental branches for the supply of the upper teeth, and 
two branches, the temporal and malar respectively, which emerge 
from foramina in the malar bone, and supply the skin over that 
bone and the fore-part of the temple. The infraorbital nerve 
itself divides into numerous branches, which are arranged in 
three sets palpebral for the skin of the lower eyelid, nasal 
for the skin on the side of the nose, and labial for the skin of 
the upper lip. 

(3) The Inferior Maxillary nerve passes through the foramen 
ovale in the base of the skull and enters the pterygoid region ; 
it gives off branches to supply the muscles of mastication 
viz., temporal, masseter, internal and external pterygoid, and 
buccinator. It then gives off five named branches (a) the 



206 



HANDBOOK OF ANATOMY 



buccal, which supplies the skin over the buccinator muscle and 
the mucous membrane inside the cheek; (b) the auriculo- 
temporal, which supplies the skin over the temple and the 
scalp just above ; (c) the inferior dental, which supplies the 
lower teeth ; (d) the lingual, which supplies the mucous 
membrane covering the anterior two-thirds of the tongue; 
(e) the mental, which supplies the skin over the chin. 



Trigeminal 
nerve 



/"Lachrymal 

Ophthalmic -j Frontal 

^Nasal 



/Supraorbital 
\Supratrochlear 



Superior maxillary 



Inferior maxillary 



Dental 

Malar 

Temporal /Talpebral 

Infraorbital -I Nasal 

Motor branches (Labial 

Buccal 

Auriculo-temporal 

Inferior dental 

Lingual 

Mental 



7. The Facial nerve passes out from the border of the pons 
varolii and through a canal in the petrous portion of the 
temporal bone. It emerges from the skull through the stylo- 
mastoid foramen, and breaks up in the substance of the parotid 
gland to supply the muscles of the face. Directly after emerg- 
ing from the stylo-mastoid foramen the nerve gives off three 
small branches, which supply respectively the stylo-hyoid, pos- 
terior belly of digastric, and the intrinsic muscles of the ear, and 
this latter also gives a branch to the posterior belly of occipito- 
frontalis. 

In the parotid gland the nerve breaks up into two main 
divisions the temporo- and cervico-facial each of which divides 
into three sets of branches. This arrangement is called the 
pes anserinus. 

The Temporo-Faeial divides up into (1) temporal, (2) malar,, 
and (3) infraorbital branches, which supply the muscles of ex- 
pression in their vicinity. 



CERVICO-FACIAL NERVE 



207 



The Cervieo-Faeial divides up into (1) buccal, (2) superior 
mandibular, and (3) inferior mandibular, all supplying muscles 
of expression; the latter branch supplies also the platysma 
muscle. 

TemporG-facial Division of Facial Nerve 
Temporal Branches of Facial Nerve 

Ma'ar Branches of Facial Nerve 



Branch of Lachrymal Nerve- 



Supra-orbital Nerve 

(in two divisions) 
.... Infratrochlear Nerve 

Malar Nerve 
Term. Br. of Nasal M, 

Infra-orbital N. 

Infra-orbital 
Branches of 
Facial Nerve 

Long Buccal 
Nerve 



Mental Nerve 



Parotid Gland 
x > Buccal Branches of Facial Nerve 

''Supramandibular Brs. of Facial Nenrfr 
nframandibular (Cervical) Branches 

of Facial Nerve 
External Jugular Vein 



Auriculo-temporal Nerve 

Posterior Auricular Nerve 
Great Occipital Nerve. 

Facial Nerve at Stylo-.--'* 
mastoid Foramen 
Digastric Branch of 
Facial Nerve 



Cervico-facial Division of 

Facial Nerve 




Small Occipital Nerve 

Great Auricular Nerve 
Superficial Cervical Nerve 



FIG. 72. NERVES OF HEAD AND FACE. 
1, Sterao-cleido-mastoid ; 2, Trapezius. 



Facial 



Muscular 

branches 

to stylo-hyoid, 

etc. 



Temporal 
Malar 



Infraorbital 
fBuccal 

Cervico - facial j Superior mandibular 
[Inferior mandibular 



208 HANDBOOK OF ANATOMY 

9. The Glosso-Pharyng'eal nerve emerges from the surface 
of the medulla oblongata, and passes through the jugular 
foramen with the pneumogastric and spinal accessory nerves. 
It passes down between the internal carotid artery and the 
jugular vein, then between the internal and external carotid 
arteries, and passes inwards to reach the tongue. The nerve 
supplies the stylo-pharyngeus muscle and the mucous membrane 
of the tongue and pharynx. 

10. The Pneumogfastric or VagUS nerve emerges from the 
surface of the medulla oblongata, and passes through the 
jugular foramen with the glosso-pharyngeal and spinal ac- 
cessory nerves. The nerve lies in the carotid sheath lying 
between the artery and the jugular vein. It then enters the 
thorax behind the large veins (on the right side it crosses the 
subclavian artery, on the left it Ties between the common carotid 
and subclavian arteries and crosses the arch of the aorta). As 
the nerves cross the arteries they each give off the recurrent 
laryngeal branches the one hooking round the subclavian 
artery, and the other round the arch of the aorta. The nerve 
then passes behind the root of the lung, where it breaks up 
into branches to form the posterior pulmonary plexus, from 
which it sends two branches to join with similar ones from 
the other nerve to form a plexus in front of the oesophagus. 
A branch from the left nerve then passes down in front of the 
oesophagus, one from the right behind the oesophagus, and 
terminates by supplying the stomach and other abdominal 
organs. 

The pneumogastric nerve supplies 

In the neck laryngeal and cardiac branches. 

In the thorax laryngeal, pulmonary, and cesophageal 
branches. 

In the abdomen stomach and branches to the coeliac, 
splenic, renal, and hepatic plexuses. 

11. The Spinal Accessory nerve is formed in two parts one 
in the medulla oblongata, the other from the spinal cord the 
two roots unite to form one trunk, which passes through the 
jugular foramen with the glosso-pharyngeal and pueumogastric 



HYPOGLOSSAL NERVE 209 

nerves. It passes down in the carotid sheath, and ends by sup- 
plying sterno-mastoid and trapezius. 

12. The Hypogflossal nerve emerges from the surface of the 
medulla oblongata and passes through the anterior condyloid 
foramen. It then passes down the neck on the outer side of 
the internal carotid artery, and hooks round the occipital 
artery to reach the tongue, the intrinsic muscles of which it 
supplies. 



14 



SECTION XVIII 
SURFACE MARKINGS 

The Head. 

ABOUT the head, the important structures whose positions are 
required are the nerves ; these have already been indicated in 
their own section. 

The Neck. 

The neck is divided up into compartments by the fascial pro- 
cesses dipping in between the muscles. The most important one 
is the central or visceral compartment, bounded anteriorly by the 
pretracheal fascia, posteriorly by the pre vertebral fascia, and 
laterally by the fascia enveloping the vascular compartment 
which contains the carotid artery, internal jugular vein, vagus 
nerve, and a chain of lymphatic glands ; they all lie just under- 
neath the sterno-mastoid. 

The central or visceral compartment lies in the middle line of 
the neck, and extends from the base of the skull into the medias- 
tinum ; anteriorly it is divided by the hyoid bone into supra- and 
infrahyoid portions. Below the hyoid bone can be felt the 
cartilages of the larynx covered by a thin layer of muscles ; and 
below them again the thyroid gland, whose middle portion lies 
over the second, third, and fourth rings of the trachea. 

The trachea starts at the level of the sixth cervical vertebra, 
and divides at the level of the fourth dorsal vertebra ; it 
gradually recedes as it passes down, and at the level of the upper 
border of the sternum is 1^ inches from the surface. 

The Thorax. 

The thorax has been divided up into areas by the use of trans- 
verse and vertical lines : 

210 



SURFACE MARKINGS 211 

Mid-sternal indicated by a furrow between the origins of the 
pectoralis major muscles. 

Mid-clavicular a line dropped from the mid-point of the 
clavicle ; should be continuous with the vertical Poupart line, 
.and passing through the tip of the ninth costal cartilage. 

Parasternal a line drawn midway between the side of the 
sternum and the mid-clavicular line, and passes through the tip 
of the eighth costal cartilage. 

Mammary region between two transverse lines drawn at the 
levels of the third and sixth chondro-sternal articulations. 

The upper border of the sternum is on a level with the lower 
border of the second dorsal vertebra, and about 2 inches 
distant from it. The junction of the manubrium with the body 
of the sternum forms a marked prominence Ludwig's angle ; at 
this point the second costal cartilage articulates, 

The Lung's. The apex of the lung extends upwards for one 
to two inches above the anterior extremity of the first rib, and is 
indicated by a curved line drawn from the upper border of the 
sterno-clavicular articulation to the junction of the inner and 
middle thirds of the clavicle, the highest part of the curve being 
from J inch to 1^ inches above the clavicle. The apex of the 
right lung is J inch higher than that of the left. The subclavian 
artery lies on the cervical pleura covering the apex of the 
lung. 

The anterior border of the right lung is indicated by a line 
drawn from the upper border of the sterno-clavicular articulation 
to the centre of the manubrium, and thence vertically downwards, 
slightly to the left of the middle line, to the level of the sixth' or 
seventh costal cartilage. 

The anterior border of the left lung is indicated by a similar 
line as far as the fourth costal cartilage ; thence along the lower 
border of the cartilage to the parasternal line, then downwards, 
to the upper border of the sixth costal cartilage in the para- 
sternal line. 

The lower border of the lung is the same on both sides, and is 
indicated by a line drawn from the lowest point of the anterior 
border along the sixth costal cartilage to the mid-clavicular line, 
and then curving slightly downwards across the chest to the 



212 HANDBOOK OF ANATOMY 

spine of the tenth dorsal vertebra ; this line crosses the eighth 
rib at the side and the tenth rib at the back. 

The pleura is a little larger than the lungs, especially inf eriorly.. 

The Heart. 

The surface markings of the heart are already given on p. 137- 

The Abdomen. 

The abdomen is most prominent in the region of the umbilicus, 
which is situated normally below the mid-point between the 
infrasternal] notch (formed by the seventh costal cartilage and 
lower border of sternum) and the symphysis pubis, a little below 
the level of the highest part of the iliac crest and opposite the 
fourth lumbar vertebra; in obese or pendulous abdomens it 
may be considerably below this level. 

The anterior abdominal wall is limited above by the infra- 
sternal notch and costal margin, and below by the fold of the- 
groin and crest of the pubes. 

In a spare subject the recti and supra-umbilical portion of 
the linea alba are easily seen; if the outline of the rectus is- 
obscured by fat, the outer border is indicated by a line drawn 
from the tip of the ninth costal cartilage down as far as the um- 
bilicus, then curving forward to the pubic spine. In the angle 
between the outer border of the rectus and the ninth costal 
cartilage on the right side lies the gall-bladder. 

The abdomen is arbitrarily divided into nine regions, by two- 
vertical and two horizontal planes. 

The mid-clavicular lines, continued downwards, cut Poupart's 
ligament in the mid-point between the anterior superior iliac 
spine and the pubic symphysis. (Note that this point is not the- 
mid-point of Poupart's ligament.) In the abdomen these are 
called the Poupart planes. 

The upper (infracostal) plane is at the level of the lowest part 
of the tenth costal cartilage, and passes through the third 
lumbar vertebra. 

The lower (inter tubercular) plane is at the level of the tubercles- 
of the iliac crests, and passes through the fifth lumbar vertebra, 

,The subdivisions of the upper zone are called the epigastric 



SURFACE MARKINGS 



213 



and right and left hypochondriac regions ; of the middle zone, the 
umbilical and right and left lumbar regions ; of the lower zone, 
the hypogastric and right and left iliac regions. 

The transpyloric plane is midway between the suprasternal 
notch and the symphysis pubis; it passes through the first 
lumbar vertebra and almost always through the pylorus ; hence 
its name. 



Livep 



.Transverse 
Co Jon. 



Ascending 
Colon 




FIG. 73. PLANE OF ABDOMEN. 



The Liver. In front the lower border of the liver can readily 
be felt as it crosses the costal angle ; it passes from the eighth 
costal cartilage on the left side to the tip of the tenth on the 
right, and in the mid-line crosses the transpyloric plane. In the 
mid-axillary line it is a little below the level of the lowest part 
of the tenth right costal cartilage. The upper border reaches 



214 HANDBOOK OF ANATOMY 

from the fifth interspace on the left side to the fourth interspace 
on the right (both points in the mid-clavicular line). 

The Stomach. The stomach lies almost entirely in the left 
half of the epigastric and the left hypochondriac regions. The 
cardiac orifice lies 4 inches from the surface at a point over 
the seventh left costal cartilage, 1 inch from the sternum ; the 
pylorus is generally about 1 inch to the right of the mid-line 
in the transpyloric plane ; its position varies slightly according 
to the state of distension of the stomach. The highest part of 
the fundus of the stomach lies under the left cupola of the 
diaphragm, and reaches the fifth interspace in the mid-clavicular 
line, a little above and behind the apex of the heart ; the lowest 
part of the great curvature lies between the transpyloric and 
infracostal planes. 

Small Intestine. The coils of the small intestine lie mainly 
in the umbilical and hypogastric regions. 

Large Intestine. The csecum, which is in the right iliac 
region, is in contact with the anterior abdominal wall just above 
the outer third of Poupart's ligament; its position otherwise 
varies according to its dilatation ; when empty, it is generally 
covered by coils of small intestine. The orifice of the appendix 
is opposite " McBurney's point," located on the surface at the 
junction of the upper and middle thirds of a line drawn from* 
the umbilicus to the right anterior superior iliac spine. 

The ascending colon lies deeply in the right lumbar region 
upon the quadratus lumborum and the right kidney. 

The hepatic flexure lies immediately to the right of the gall- 
bladder beneath the tenth costal cartilage. 

The transverse colon crosses the upper part of the umbilical 
region; it forms a U-shaped loop which reaches for a variable 
distance below the umbilicus ; when the intestines are distended 
it may ascend in front of the stomach. 

The splenic flexure reaches upwards behind the stomach, and 
touches the lower extremity of the spleen. 

The descending colon lies deeply in the left lumbar region. 

The iliac and pelvic portions of the colon lie in the left iliac 
fossa and true pelvis respectively. 

The Kidneys. Unless enlarged or displaced, the kidneys can 



SURFACE MARKINGS 215 

seldom be felt through the abdominal wall. The right kidney as 
a rule lies a little lower than the lef t, and a little further from 
the mid-line. For practical purposes the hilum of the kidney 
may be regarded as opposite a point J inch internal to the 
tip of the ninth costal cartilage ; and a line joining the two hili 
is in the transpyloric plane. 

The Abdominal Aorta. The abdominal aorta commences 
about 1 inch above the transpyloric plane, and bifurcates a 
little to the left of the mid-line on a level with the highest part 
of the iliac crest, generally about f inch below the umbilicus, 
opposite the fourth lumbar vertebra. 

The Back. 

In the middle line of the back is the spinal furrow, along 
which the spines of the vertebrae can be easily palpated, 
becoming more distinct when the spine is flexed. 

The spine of the first dorsal vertebra is more prominent than 
that of the vertebra prominens (seventh cervical), the third dorsal 
is on a level with the root of the spine of the scapula, the 
seventh dorsal with its inferior angle, the fourth lumbar with 
the highest part of the iliac crest, and the second sacral with 
the posterior superior iliac spine. 

Over the upper sacral region is a flattened triangular area, the 
angles of which correspond with the posterior superior iliac 
spines and the third sacral vertebra. 

Above the spine of the scapula is the suprascapular region ; 
the levator anguli scapulae and trapezius muscles can easily be 
seen by shrugging the shoulders. The lower border of the 
trapezius is indicated by a line from the twelfth dorsal spine to 
the root of the spine of the scapula. 

The upper border of the latissimus dorsi is indicated by a line 
extending outwards from the sixth dorsal spine across the angle 
of the scapula. 

The outer border of the erector spinse is indicated by drawing 
a line from a point on the iliac crest 3 J inches from the mid-line 
upwards and outwards to the angles of the ribs. The outer 
border of quadratus lumborum lies external to that of the erector 
spinas at the iliac crest and internal to it at the twelfth rib. 



216 HANDBOOK OF ANATOMY 

As a rule the tip of the twelfth rib lies 2 inches vertically 
above the centre of the iliac crest. 

The " triangle of Petit" is a narrow triangular space formed 
by the outer border of latissimus dorsi, the posterior border 
of obliquus externus, and the iliac crest. 

The Kidneys. The upper limit of the kidney is indicated by 
a line drawn transversely at the level of the eleventh dorsal 
spine, the lower limit by one at the level of the third lumbar 
spine. About a third of the kidney lies above the lower margin 
of the twelfth rib, the left kidney about J inch higher than 
the right. The most external point of the outer border lies 
4 inches from the mid-line and the hilum lies H inches from 
the mid-line between the tips of the transverse processes of the 
first and second lumbar vertebrae. 

The Diaphragm and Liver. Posteriorly the right arch of 
the diaphragm and the right lobe of the liver extend upwards to 
the level of the angle of the scapula (eighth rib), while the left 
arch lies 1 inch lower; the central tendon is on a level with 
the eighth dorsal spine. The right lobe of the liver is covered 
posteriorly by the eighth to the twelfth ribs. 

The Spleen is situated in the left hypochondrium behind the 
cardiac end of the stomach, and is overlapped by the ninth, 
tenth, and eleventh ribs, the long axis corresponding to that of 
the tenth rib. 

The anterior angle is at the level of the ninth interspace in the 
mid-axillary line. The vertebral angle lies 1J inches external to 
the tenth dorsal spine. The inferior angle lies opposite the 
eleventh interspace on a level with the first lumbar spine : with 
these points the whole organ can be mapped out. 

The Upper Extremity. 

The Shoulder. The shaft of the clavicle is subcutaneous 
throughout. The tip of the acromion lies a little external to and 
in front of the outer end of the clavicle; and its outer border 
can be followed round along the spine of the scapula, the root 
of which is on a level with the third dorsal vertebra. The 
inferior angle and internal border of the scapula are easily felt. 
The tip of the coracoid process can be felt at the anterior border 



SURFACE MARKINGS 217 

of the deltoid 1 inch below the point joining the middle and 
outer thirds of the clavicle. Internal to the coracoid process is 
a triangular depression between pectoralis major and deltoid ; in 
this depression can be felt the axillary artery. 

The rounded contour of the shoulder is formed by the upper 
end of the humerus covered by the deltoid; both tuberosities can 
be felt ; the head of the humerus can be felt through the axilla. 

The Axilla. The anterior fold of the axilla is formed by the 
lower border of pectoralis major and the posterior fold by latis- 
simus dorsi and teres major ; between the two folds is the prom- 
inence of coraco-brachialis, behind which can be felt the third 
part of the axillary artery. High up in the axilla a few 
lymphatic glands can be felt. 

The Upper Arm. The anterior and posterior borders of the 
deltoid can be traced in their whole extent; just under the 
posterior border, about half-way down, the circumflex, artery and 
nerve and the musculo-spiral nerve enter the arm. The internal 
supracondyloid triangle, limited by the internal intermuscular 
septum posteriorly, and whose floor is formed by the inner part 
of brachialis anticus, contains many important structures ; from 
without inwards, the brachial artery, the median nerve, the lower 
part of the basilic vein, the internal cutaneous nerve, and two or 
three lymphatic glands. 

The external intermuscular septum extends upwards from the 
external condyle to the insertion of the deltoid, and is pierced a 
third of the way down by the musculo-spiral nerve. 

The posterior compartment of the upper arm is occupied by 
the triceps, the tendon of which can be felt at its insertion into 
the olecranon. 

The brachial artery, overlapped above by coraco-brachialis and 
below by biceps, can be felt throughout the whole length of the 
internal bicipital furrow. The course oi. the vessel is mapped 
out by a line drawn from the inner border of the coraco- 
brachialis, at the level of the posterior fold of the axilla, to a 
point (opposite the neck of the radius) J inch below the middle 
of the bend of the elbow. 

The cephalic vein ascends internal to the outer edge of triceps 
to the interval between the deltoid and pectoralis major. 



218 HANDBOOK OF ANATOMY 

The line of the median nerve is the same as that of the brachial 
artery. The course of the ulnar nerve is mapped out by a line 
extending from the posterior fold of the axilla behind coraco- 
brachialis to the back of the internal condyle of the humerus. 

The course of the musculo-spiral nerve is mapped out by a line 
drawn from the point where it pierces the intermuscular septum 
(the junction of the upper and middle thirds of a line extending* 
from the insertion of the deltoid to the external condyle) to the 
front of the external condyle; and obliquely upwards to the 
point where the posterior fold of the axilla joins the upper arm. 

The Elbow. 

The head of the radius can be felt 1 inch below the external 
condyle of the humerus when alternately pronating and supinating 
the flexed forearm. 

The median vein is seen to bifurcate J inch below the middle 
of the bend of the elbow ; deep to this, beneath the fascia, is the 
bifurcation of the brachial artery. 

The biceps tendon can be traced vertically through the centre 
of the bend of the elbow with the forearm flexed. 

The Forearm and Hand. 

The lower half of the radius is easily felt, and the anterior 
border of the lower extremity forms a ridge 1 inch above the 
ball of the thumb, and just below is the radio-carpal articulation. 
Upon the middle of the posterior border of the lower extremity 
is the radial tubercle between the tendons of extensor longus 
pollicis and extensor carpi radialis brevior. 

The posterior border of the ulna is subcutaneous throughout, 
and its lower extremity forms a rounded prominence anterior to 
which is the styloid process. Between the two lies the tendon of 
extensor carpi ulnaris. 

The carpal bones form an arch bridged by the anterior annular 
ligament; the bony attachments of the latter form important 
landmarks. 

The tubercle at the base of the third metacarpal can be felt 
If inches below the tubercle on the back of the lower end of the 
radius. 



SURFACE MARKINGS 

The prominences of the knuckles are formed by the heads of 
the metacarpal bones. 

Anteriorly, the metacarpo-phalangeal articulations are situated 
| inch above the level of the web of the fingers. 

The course of the radial artery is indicated by a line drawn 
from the bifurcation of the brachial artery to the tubercle of the^ 
scaphoid. 

The upper third of the ulnar artery follows a curved line from 
the bifurcation of the brachial artery to the inner side of the- 
anterior surface of the forearm ; the lower two-thirds are on a 
line drawn from the front of the internal condyle to the pisiform 
bone. The course of the ulnar nerve corresponds to the whole of 
that line. 

The median nerve may be mapped out by a line drawn from a 
point midway between the mid-point of the bend of the elbow 
and the internal condyle to a point midway between the two 
styloid processes. 

The radial nerve follows the radial artery in the upper part of 
its course ; at the junction of the middle and lower thirds of the 
forearm it winds round beneath supinator longus to the back of 
the forearm. 

The summit of the superficial palmar arch is on the mid-point 
of a line drawn from the lowest transverse crease on the wrist to 
the root of the middle finger. The deep arch lies transversely 
midway between the lower border of the anterior annular 
ligament and the superficial arch. 

The Lower Extremity. 

The buttock extends from the crest of the ilium above to the- 
gluteal fold below. The highest point of the iliac crest is on a 
level with the fourth lumbar spine ; the anterior superior spine of 
the ilium limits the groin externally ; the posterior superior spine^ 
indicated on the surface by a dimple, is on a level with the 
second sacral spine, and corresponds to the middle of the sacro- 
iliac joint. A hand's breadth below the tubercle of the crest 
is the great trochanter of the femur, which is best felt if the 
limb is slightly abducted and rotated. 

Nelaton's line, drawn from the anterior superior spine of the- 



220 HANDBOOK OF ANATOMY 

ilium to the ischial tuberosity, crosses the hip at the level of the 
upper border of the great trochanter. 

The ischial tiiberosity, in the erect posture, is overlapped by 
the lower border of glutens maximus; it can be felt a little 
above the inner part of the gluteal fold. If the hip be rotated 
inwards, the lesser trochanter can be felt above the outer end 
of the gluteal fold. 

Anteriorly the buttock is limited by the tensor fascise femoris 
muscle. 

At a point corresponding to the junction of the upper and 
middle thirds of a line drawn from the posterior superior spine 
of the ilium to the ischial tuberosity, the gluteal artery and great 
sciatic nerve enter the buttock ; from this point the nerve passes 
downwards and outwards upon the ischium to a point midway 
between the tuberosity and the great trochanter. 

The Back of the Thigh, 

The hamstring muscles are thrown into prominence by standing 
on tiptoes, or by flexing the leg against resistance ; at the same 
time a well-marked furrow indicating the external intermuscular 
septum of the thigh is seen ; behind this furrow is the biceps, 
and in front of it the vastus externus. 

The course of the great sciatic nerve corresponds to the upper 
half of a line extending from a point midway between the ischial 
tuberosity and the great trochanter to the middle of the 
popliteal space ; the small sciatic nerve, indicated by the same 
line, descends superficial to the biceps, while the great sciatic 
nerve lies under cover of it. 

The external popliteal nerve can be felt as it descends im- 
mediately behind the tendon of biceps and the head of the fibula. 

The internal popliteal nerve and popliteal vessels are indicated 
by a line drawn from a point a little internal to the upper angle 
of the popliteal space, to a point midway between the condyle 
of the femur, and thence down the middle of the space to the 
level of the lower part of the tubercle of the tibia. 



SURFACE MARKINGS 221 

The Front of the Thigh. 

Poupart's ligament, in the fold of the groin, divides the front 
of the thigh from the abdomen. Comparative measurements of 
the length of the limbs are made from the anterior superior 
spine of the ilium to either of the malleoli with the pelvis 
horizontal. 

The long saphenous vein is indicated by a line drawn from the 
adductor tubercle of the femur to the lower part of the saphenous 
opening (1^ inches below and external to the pubic spine). 

The course of the femoral artery is mapped out, with the 
thigh slightly flexed and rotated outwards, by a line drawn from 
a point midway between the anterior superior spine and the 
symphysis pubis, to the adductor tubercle of the femur ; the 
upper third of this line corresponds to the part of the artery in 
Scarpa's triangle, and the middle third to that in Hunter's canal. 

The Knee. 

The patella can be easily outlined and moved from side to side 
with the knee extended and the quadriceps relaxed; with the 
quadriceps contracted the patellar ligament can be traced to its 
insertion. In semiflexion, the inner margin of the internal 
condyle, the upper border of the inner tuberosity of the tibia, 
and the lower part of the patella, are distinctly visible, and 
together bound a triangular depression which overlies the line of 
the joint and the anterior part of the internal semilunar cartilage. 

The Leg 1 . 

The inner surface of the tibia is subcutaneous throughout. 

The shaft of the fibula, somewhat posterior to the tibia, is only 
subcutaneous just above the malleolus. 

The extensor and peroneal muscles, when thrown into action,, 
are mapped out on the surface by grooves corresponding to the 
intermuscular septa. 

The cutaneous part of the musculo-cutaneous nerve corresponds 
to the lower half of a line drawn from the anterior border of the 
head of the fibula to the anterior border of the external malleolus. 

The anterior tibial artery enters the leg two inches below the 



222 HANDBOOK OF ANATOMY 

tubercle of the tibia ; in the upper two-thirds of its course it lies 
on the interosseous membrane ; in its lower third it lies on the 
front of the tibia and terminates in front of the ankle-joint mid- 
way between the two malleoli. 

The short saphenous vein, which lies a little to the outer side of 
the tendo Achillis, gradually reaches the middle of the calf and 
ascends to the popliteal space. The internal saphenous vein and 
nerve lie along the inner border of the tibia. 

The course of the posterior tibial artery is indicated by a line 
drawn from the lower angle of the popliteal space to a point 
midway between the internal malleolus and the tendo Achillis. 
The peroneal artery, beginning three inches below the head of 
the fibula, is indicated by a line from that point to one midway 
between the external malleolus and the tendo Achillis. 

The Foot. 

The tip of the external malleolus is J inch lower and f inch 
posterior to that of the internal 'malleolus. The line of the ankle- 
joint can be felt on either side of the extensor tendons, and when 
the foot is extended a prominence is formed by the anterior part 
of the superior articular surface of the astragalus below the 
anterior border of the lower end of the tibia. 

A finger's breadth below the tip of the internal malleolus is 
the sustentaculum tali ; 1J inches in front of the latter is the 
tubercle of the scaphoid ; close above it is the tendon of tibialis 
posticus. 

A finger's breadth below the tip of the external malleolus is 
the peroneal tubercle of the os calcis, a guide to the two peronei 
tendons. 

The line of the tarso-metatarsal joints extends nearly 1 inch 
further forwards on the inner than on the outer surface of 
the foot. 

The metatarso-phalangeal joints are situated one inch behind 
the web of the toes. 

Crossing the front of the ankle-joint, from within outwards, 
are the tendons of tibialis anticus, extensor longushallucis, extensor 
longus digitorum } and peroneus tertius. The extensor brevis digi- 
torum forms a fleshy pad over the calcaneo-cuboid joint. The 



SURFACE MARKINGS 223 

abductor hallucis forms a fleshy pad along the inner border of 
the foot. 

The dorsalis pedis artery is mapped out by a line drawn from a 
point midway between the two malleoli (the termination of the 
anterior tibial artery) to the hinder end of the first interosseaus 
space. The internal saphenous vein and nerve lie between the 
internal malleolus and the tendon of tibialis anticus ; the external 
saphenous vein and nerve follow the tendon of peroneus brevis. 

The internal plantar vessels and nerves lie along a line drawn 
from the under surface of the inner tuberosity of the os calcis to 
the interval between the first and second toes. The external 
plantar vessels and nerves are on a line drawn from the middle of 
the under surface of the heel to the fourth toe; the course of 
the plantar arch is mapped out by a line drawn across the sole 
from the inner side of the base of the fifth metatarsal to the 
hinder end of the first interosseous space. 



INDEX 



ABDOMEN, 212-13, 214 
Abdominal cavity, 116, 117 

wall, 125, 126, 212, 214, 215 
Abductor hallucis, 223 

minimi digiti, 74 
Accessorius, 74 
Acetabulum, 39, 41 
Acromion, 36, 216 
' ; Adam's apple," 132 
Alimentary canal, 3, 116 
Alveolar border, 107 
Anal canal, 122 
Anatomy, definition of, 1 
Antrum of Highmore, 108 
Aorta, 126, 136, 140-41 

abdominal, 141, 142, 215 

arch of, 141, 142, 143 

ascending, 140, 141, 142 

branches of, 142-3 

descending thoracic, 134, 141-2 
Aortic valve, 139 
Appendices epiploicse, 121 
Appendix, 121, 139, 214 
Arachnoid mater, 174, 175 
Arm, upper, 217 seq. 
Arteries, 3, 137 

anastomotic, of elbow, 158 

of aorta, 140-41 

axillary, 157, 162 

brachial, 157-8, 217, 218, 219 

carotid, common, 127, 143, 

145, 210 
external, 145 
internal, 145, 174 

carpal, 159 

circumflex, 157, 217 

coaliac axis, 149 

dorsalis pedis, 167, 223 

femoral, 148, 163-4, 221 

gastric, 149 

gluteal, 220 

hepatic, 125, 149-50, 154 

iliac, 147-8, 154 

innominate, 143 

intercostal, 146 

interosseous, of arm, 159 

of lower limb, 163 seq. 



14C. 



144, 



Arteries of upper limb, 157 seq. 

lumbar, 147 

mammary, internal, 144, 146 

maxillary, internal, 145 

mesenteric, inferior, 151 

superior, 143, 150-51, 154 

occipital, 143 

ovarian, 149 

palmar arches, 160, 219 

peroneal, 165, 222 

phrenic inferior, 146, 147 

plantar, 166 

popliteal, 164-5 

profunda, of arm, 158 

pulmonary, 134, 139, 140 

radial, 158-9 

renal, 129, 149 

sacral, middle, 149 

spermatic, 149 

splenic, 149 

subclavian, 87, 142, 145-6, 211 

subcostal, 146 

subscapular, 157 

suprarenal, 149 

temporal, superficial, 143 

thyroid axis, 146 

tibial anterior, 166-7, 221, 223 
posterior, 76, 165, 222 

ulnar, 158, 159, 160, 219 

vertebral, 145, 174 

volar, 158 
Articulation, chondro -sternal, 211 

lumbo -sacral, 148 

metacarpo-phalangeal, 219 

radio -carpal, 218 

sterno -clavicular, 143, 145 
Articulations, intercentral and inter 

neural, 89 

Astragalus. See Bones 
Atlas. See Bones 
Auricles, 137, 138, 139 
Auricular appendix, 139 
Auriculo-ventricular groove, 139 

orifice, 139 

Axilla, 36, 38, 217, 218 
Axillary border, 8 
Axis. See Bones 



224 



INDEX 



225 



Back (the), 215-16 
Biceps. See Muscles 
Bicipital furrow, 217 

groove, 130 
Bicuspid valve, 130 
Bile, 123, 125 

papilla, 121 
Bladder, 129 
Bones, classification of, 2 

astragalus, 45, 49, 51, 222 ' 

atlas, 82 

arches of, 112 
axis, 82 

carpal, 30, 218 

aarpus, 5, 13 

clavicle, 5, 6, 211, 217 
shaft of, 216 

coccyx, 42, 82 

of cranium, 100 

cuboid, 49, 51, 53 

cuneiform, 13, 26, 49, 51 

ethmoid, 100, 107 

femur, 43 

adductor tubercle of, 221 

fibula, 47, 65-66 

head of, 220, 221, 222 
shaft of, 221 

frontal, 100, 101, 102, 104 

of head, 100 seq, 1 14 seq. 

humerus, 5, 8-10, 217, 218 

hyoid, 110, 210 

ilium, 39-41, 53 

spines of, 39-40, 54 

innominate, 39 

ischium, 39, 41, 42, 54, 220 

lachrymal, 100 

malar, 100, 102, 104, 108, 109 

mandible, 100, 100-10, 111 

manubrium sterni, 83, 211 

maxillae, 100, 102, 131 

metacarpal, 219 

metatarsal, 70, 223 

occipital, 100, 101, 102, 105-6 
protuberance, external, 105 

os calcis, 49, 51, 70, 222 

parietal, 100, 102, 104 

phalanges, 5, 15, 31 

pisiform, 13, 219 

pubis, 39, 41, 42, 56 

radius, 5, 12-13, 23, 218 

ribs, 2, 86 ? 88, 90, 215, 216 
angle of, 86 

sacrum, 41, 42, 53, 79, 83 
promontory of, 80 

scaphoid, 5, 49, 51, 70 

scapula, 5, 6-8, 215 
angles of, 216 
spine of, 36, 215, 216 

semiluriar, 5, 13 

esam6id, 2 



Bones, sphenoid, 100, 102, 107 

great wings of, 107 
sternum, 83, 210, 211, 212, 214 
tarsus, 49, 53 

temporal, 100, 101, 106-7, 110 
tibia, 45-47, 221, 222 
tubercle of, 220 
trapezium, 13 
turbinate inferior, 100 
ulna, 5, 10-12, 23, 218 
unciform, 13 
vertebrae, 2, 78-9 

cervical, 82-3, 210, 215 
dorsal (thoracic), 82, 210, 21 i t 

215 

joints of, 89 
laminae of, 79 
lumbar, 211, 213, 215, 216 
prominens, 215 
sacral, 215 

spines of, 80, 212, 215 
vomer, 100 

Brachialis anticus. See Muscles 
Brain, 171 seq. 

blood-supply of, 173 seq. 
coverings of, 174 
Bronchi, 133-4 
Bronchial nerve, 134 

vessels, 134 
Buttock, 219 

Csecum, 121, 214 

Capitellar surface, 21 

Capitellum, 10 

Cardiac end of stomach, 119, 216 

opening of stomach, 119 

orifice, 214 

i Cartilage, costal, 37, 86, 123, 124, 125, 
136, 137, 142, 211, 212, 213, 
214, 215 

cricoid, 132 

ensiform, 83, 89, 136 

of larynx, 210 

semilunar, 63, 221 

thyroid, 127, 132, 143 

xiphoid. See Ensiform 
Cauda equina, 176 
Cerebellum, 173 
Cerebral peduncles, 174 
Cerebro- spinal system, 172 
Cerebrum, 173 
Circle of Wjllis, 145, 175 
Circulatory^ system, 3 
Clavicle. See Bones 
Coccyx. See Bones 
Colon, ascending, 121, 213, 214 

descending, 122, 213, 214 

iliac, 122, 214 

pelvic, 122, 214 

transverse, 122, 213, 214 

15 



226 



HANDBOOK OF ANATOMY 



Colons, 118 

Condyle, external, 217, 218 

internal, 219, 221 

of femur, 220 
Conus medullaris, 175 
Coraco-brachialis.- See Muscles 
Coracoid process. See Process 
Costse. See Ribs 
Costal angle, 213 

attachment, 135 

margin, 212 
Cranium, 101 seq. 
Crural canal, 76 
Cuboid. See Bones 
Cuneiform. See Bones 

Deltoid, 217, 218 

Diaphragm, 89, 96, 116, 120, 129, 133, 
134, 135, 137, 140, 142, 146, 
147, 216 

arches of, 216 

crura of, 142, 149 

cupola of, 214 

Digestive system, 3, 116 seq. 
Digital sheaths, 36, 38 

of toes, 77 
Dorsal vertebra. See Bones: Vertebrae 

spine, 215, 216 
Ducts, bile, 121, 125, 126 

cystic, 125 

hepatic, 125 

lymphatic, 169 

pancreatic, 121, 126 

of Rivini, 123 

Stenson's, 122 

thoracic, 169 

Wharton's, 123 

Duodeno-jejunal flexure, 120, 121 
Duodenum, 3, 116, 120-121 
Dura mater, 174, 175 

Endocardium, 139 

Epigastric region of abdomen, 117 

Epigastrium, 119 

Epiglottis, 132 

Erector spinae, 215 

Ethmoid. See Bones 

Eustachian tube, 131 

valve, 139 
Expiration, 97, 131 
Expression, muscles of, 112 
Extensor brevisdigitorum* 

carpi radialis brevior 

uln f. ri * See Muscles 

longus digitorum 

hallucis 

pollicis 
Extensors, 37 
Extremity, lower, 219-20 
upper, 216-17 



Face, muscles of, 112 
Fascia, axillary, 36 

bicipital, 36 

deep, of lower limb, 76 
of perineum, 54 
of shoulder and upper limb, 

36,37 
of trunk, 98 

lumbar, 54, 99 

palmar, 36 

plantar, 70, 74, 77 

pretracheal, 210 

pre vertebral, 210 

Sibson's, 135 

superficial, 4 
Femoral sheath, 76 
Femur. See Bones 
Fibula. See Bones 
Filum terminale, 174 
Fold of Douglas, 99 
Fontanelles, 102 
Foot (the), 222-3 

arches of, 69 
Foramen magnum, 175 

mental, 109 

obturator, 41, 59 

ovale, 107 

rotundum, 107 
Foramina, intervertebral, 79 

jugular, 174 

sacro-sciatic, 54 
Forearm, 218-19 
Fossa, antecubital, 36, 38, 159 

articular (glenoid), 110 

coronoid, 10, 22 

digastric, 109 

digital, 49 

glenoid (articular), 110 

iliac, 41, 121, 122, 214 

olecranon, 10 

pelvic, 214 

sigmoid, 10, 21 

supracapitellar, 22 
Frontal bone. See Bones 
Fundus of stomach, 134 

Gall-bladder, 123, 124, 125, 212, 214 
Ganglia, 171, 178-9 

semilunar, 180 

sympathetic, 179 
Gastric surface, 129 
Genital organs, 130, 148 
Glands, antecubital, 170 

axillary, 160, 170 

cervical, 170 

ductless, 127, 129 

facial, 170 

femoral, 171 

of head and neck, 170 

of lower extremity, 170 



INDEX 



227 



Glands, lymphatic, 76, 127, 134, 169, 217 

mastoid, 170 

occipital, 170 

pancreas, 125 

parotid, 122, 145 

popliteal, 171 

salivary, 116, 122 

sublingual, 123 

submaxillary, 122-3 

thyroid, 127, 210 

of trunk, 171 

of upper extremity, 170 
Glenoid cavity, 7, 8, 10 

fossa, 18 

ligament, 19 
Gluteal fold, 220 

surface, 40 

Gluteus maximus. See Muscles 
Grey matter of brain, 174 

spinal cord, 175 
Groin, fold of, 212 

Hand, pronation and supination of, 24 
Head, bones of, 100 

movements of, 114 

muscles of, 112 

surface markings of, 210 
Heart, 3, 134, 137 seq. 

apex of, 137, 138, 139, 214 

base of, 137, 138 

interior, 139 

orifices of, 138 

surface, anterior inferior, 138-9 
superior, 138 

valves of, 140 
Hepatic artery, 125 

flexure, 121, 125, 214 

veins, 125 
Hilum of kidney, 149, 215, 216 

spleen, 149 
Hilus, 128, 129 

Horns of grey matter, 175-6 Q 

Humerus. See Bones 
Hunter's canal, 163, 167, 194, 195; 221 
Hyoid. See Bones 
Hypochondrium, 119, 123, 127 
Hypogastric region of abdomen, 117 

Ileum, 116, 120, 131 

Iliac crest, 117, 212, 214, 215, 219 

region, 117 

spine, 214, 215, 219, 221 
Ilio-tibial band, 76 
Ilium. See Bones 
Infracostal line, 213 

plane, 214 

Infrasternal notch, 212 
Inguinal canal, 149 
Innominate bone. See Bones 
Inspiration, 97, 131 



Intercostal spaces, 124, 135, 137, 146 
Intermuscular septa, 218, 220, 221 
Interosseous membrane, 222 

space (first), 223 
Intertrochanteric line, 55, 56 

ridge, 55 
Intertubercular line, 117 

plane, 213 

Intervertebral disc, 89 
Intestines, 3, 116, 117, 118, 120-21, 214 
Ischial spine, 41, 42 

tuberosity, 220 
Ischium. See Bones 

Jejunum, 116, 120, 121 
Joints, 2 

aero mio- clavicular, 16 

muscles acting on, 16-17 
ankle, 66, 222 

muscles acting on, 70 
calcaneo -cuboid, 222 
carpo-metacarpal, 28-9 
elbow, 21-24 

muscles acting on, 23 
hip, 54 seq. 

muscles acting on, 56 seq. 
intercarpal, 28 
intermetacarpal, 31 
interphalangeal, 33 

muscles acting on, 74 
intertarsal, 68 
knee, 2, 59 

muscles acting on, 64 
lumbo -sacral, 53 
metacarpo-phalangeal, 31, 32 

muscles acting on, 33 
rnetatarso-phalangeal, 68, 222 

muscles acting on, 25 
radio -ulnar, 24, 25 

muscles acting on, 25 
sacro-iliac, 53, 219 
shoulder, 18 

muscles acting on, 112 
skull, 110 

niuscles acting on, 112 
sterno- clavicular, 15 
symphysis pubis, 54 
tarso-metatarsal, 68, 222 
temporo-mandibular, 110 

muscles acting on, 114 
tibio-fibular, 65-66 
vertebral, 89-90 
wrist, 26 

Kidneys, 129-30, 214-15, 216 

Knee (the), 221 

Knuckles, prominences of, 219 

Lachrymal bone, 100 
Lambdoid suture, 102 



228 



HANDBOOK OF ANATOMY 



Larynx, 116, 131-2,210 
Leg (the), 221-2 
Ligament, definition of, 2 
Ligamenta denticulata, 175 

flava, 89 

Ligaments, of acromio-clavicular joint, 
16, 19 

annular, 37, 76, 89, 166, 167, 218, 
219 

of atlas, 90 

of axis, 90 

calcaneo-cuboid, 68 

navicular (spring), 68 

carpal, 26-28 

coraco-acromial, 19 

coraco-clavicular, 16 

coraco -humeral, 19 

conoid, 16 

costo-coracoid, 36 

cotyloid, 55 

crucial, 63 

deltoid, 67-8 

of elbow- joint, 21-23 

falciform, 124 

gastro- splenic, 128 

glenoid, 19 

gleno- humeral, 19 

ilio-femoral (Y-shaped of Bigelow), 
56 

ilio -lumbar, 53 

interclavicular, 15 

interspinous, 89 

ischio-capsular, 56 

lieno-renal, 128 

longitudinal, 89 

lumbp-sacral ^lateral), 53 

occipito-atlantoid, 112 

occipito-axoid, 112 

odontoid, 112 

palmar, 33 

patellar, 62, 63, 221 

of perineum, 54 

plantar, 68 

Poupart's, 76, 96, 129, 167, 171, 
194, 195, 212, 214, 221 

pubo -femoral, 56 

radial lateral, 32 

of radio-ulnar joint, 24, 25, 26 

rhomboid, 6, 15 

sciatic, 54 

spheno -mandibular f 111 

stylo -mandibular, 111 

subpubic, 54 

supraspinous, 89 

temporo -mandibular, 111 

transverse (humeral), 19; (meta- 
carpal), 33 ; (hip-joint), 55 ; 
(knee-joint), 63 

trapezoid, 6, 16 
ulnar, 32 



Liganientum cruciatum, 112 

nuchse, 90 

patellae, 47-59 

teres, 56 

Limb, upper, 5 seq. 
Limbs, 2-3 
Linea alba, 212 
Lingula, 110, 111 
Liver, 116, 123-5, 213-14, 216 
Ludwig's angle, 211 
Lumbar region, 214 

spine, 216 

Lungs, 3, 97, 131, 133-4, 135, 140, 211. 
12 

roots of, 134 
Lymphatic capillaries, 168 

vessels, 168, 169-71 

McBurney's point, 214 
Malar. See Bones 
Malleoli, 76, 221, 222, 223 
Malleolus, external, 49, 66, 67 

internal, 47, 68 
Mammary region, 211 
Mandible. See Bones 
Manubrium sterni. See Bones 
Mastication, muscles of, 112 
Maxillae. See Bones 
Mediastinum, 135, 210 
Medulla oblongata, 173 
Mesenteric region, 149 
Mesial plane, 1 
Mid-axillary line, 134, l'*6, 213, 

216 
Mid-clavicular lines 212, 214 

plane, 213 

Mid-Poupart plane, 129 
Mitral valve, 139 
Muscles of abdomen, 92-3 ' 

abductor brevis poll., 33, 34 

hallucis, 73, 74, 223 
longus poll., 34 

minimi digiti, 35 
accessorius, 72 
adductor, 8 
brevis, 58 
longus, 58 
magnus, 58 
obliquus hall., 73 
trans versus hall., 73 
obliquus poll., 34 
trans versus poll., 34 
anconeus, 23 
of back, 90-91 
biceps, 20, 21, 22 

femoris, 57, 64 
brachialis anticus, 12, 23 
brachio-radialis, 23, 25 
buccinator, 114, 122 
chordae tendinese, 140 



INDEX 



229 



Muscles, columnse cornese, 140 
complexus, 92, 95, 115| 
coraco-brachialis, 10, 20, 21 
crureus, 65 
deltoid, 10, 20, 21 
diaphragm, 96 
digastric, 109, 114. 
epicranial aponeurosis, 113 
erector spinse, 92, 95, 99 
of expression, 114 ^ t ^ 
extensor, 221 

brevis dig., 73, 222 

poll., 31, 34 
carp. rad. brevier, 30, 31, 218 

longior, 30, 31 
umaris, 30, 31, 218 
communis dig. (hand), 30, 35 

(foot), 70 
indicis, 31, 35 
longus dig., 222 
hall., 222 
poll., 30, 33 
minimi dig., 30, 35 
ossis metacarp. poll., 30 
proprius hall., 70, 73 
extensors of back, 98 
flexor brevis dig., 74 
hall., 74 
minimi dig. (hand), 35 

(foot), 73 
poll., 33 
carpi radialis, 29, 31 

ulnaris, 29, 31 
longus dig., 72, 73 
hall., 72, 74 
poll., 33 

profundus dig., 29, 35 
sublimis dig., 29, 35 
gastrocnemius, 64, 71 
gluteus maximus, 57 
medius, 57, 58 
minimus, 57, 58 
gracilis, 57, 58, 64 
hamstring, 220 
iliacus, 56, 148 
infraspinatus, 20, 21 
intercostal ext., 97 

int., 98 

interossei, dorsal (hand), 34, 35 
palmar (hand), 35 
plantar (foot), 74 
interspinal, 92 
latissimus dorsi, 17, 20, 21, 38, 92, 

96, 98, 215, 216, 217 
levator anguli scapulae, 16, 92, 215 
ani, 122, 130 
longus colli, 94, 143, 145 
lumbricales (foot), 72 

(hand), 35 
masseter, 113, 122 



Muscles of mastication/ 113-14 
mylohyoid, 123 
obliquus ext. abd., 94 

inf., 115 

int., 94 

sup., 115 
obturator ext., 59 

int., 59, 130 
occipito-frontalis, 112 
opponens min. dig., 34 

poll., 33, 34 
palmaris longu^, 29, 37 
papillary, 140 
pectineus, 57, 58 

pectoralis major, 17, 19, 21, 98, 
211, 217 

minor, 17, 98 
peroneal, 221 

peroneus brevis and longus, 222, 
223 

tertius, 70, 222 
plantaris, 64, 71 
popliteus, 64 
pronator quadratus, 25 

radii teres, 23, 25 
psoas, 56, 94, 120, 121, 122, 129, 

130, 147, 148, 149 
pterygoid ext. and int., 113 
pyriformis, 59 
quadratus femoris, 59 

lumborum, 95, 129, 147, 214, 

215 

quadriceps, 221 
rectus abdominis, 94, 99 
sheath of, 99 

cap. ant., 143 

cap. post., 115 

femoris, 56, 64 
rhomboid, 92 
rhomboideus major, 16 

minor, 17 
rotatores, 92 
sartorius, 56, 64 
scalenus anticus, 93, 143 

medius, 93, 145 

posticus, 93 
of scalp, 112 
soleus, 71 
splenius cap., 92, 95, 115 

cerv., 92, 95 
sterno-mastoid, 17, 98, 115, 123, 

127, 210 

subclavius, 6, 17, 37 
subscapular, 8 

supinator brevis and longus, 25 
supraspinatus, 21 
temporal, 113 

tensor fasciae fern., 58, 59, 220 
teres major, 20, 21, 38, 217 

minor, 21, 38 



230 



HANDBOOK OF ANATOMY 



Muscles of thorax, 96 

tibialis anticus, 70, 71 
posticus, 71 

transversalis, 94 

trapezius, 16, 17, 92, 215 

triangularis sterni, 98 

triceps, 10, 20, 21, 23, 38, 217 

of trunk, 90 

vastus ext., 64, 220 

int., 65 

Muscular system, 3 
Musculi pectinati, 139 
Musculo-spiral groove, 10 
Mylohyoid ridge, 109 

Neck, compartments, of 210 

glands of, 169 

mid-clavicular and sternal areas of, 
211 

surface markings on, 210 

"surgical," 8 
Nelaton's line, 219 
Nerves, auriculo-temporal, 206, 207 

buccal, 206, 207 

cervical, 176, 181 

cervico -facial, 206, 207 

circumflex, 184, 190, 217 

coccygeal, 176, 192 

cranial, 174, 204 seq. 

crural, 192, 194, 195 

cutaneous, 189-90, 193, 194, 217 

dental, 110, 204, 205 

dorsal, 176 

facial, 206 

frontal, 206 

genito -crural, 192, 194 

glosso-pharyngeal, 208 

gluteal, 197 

hypoglossal, 209 

ilio-hypogastric, 192-3 

ilio-inguinal, 193 

infraclavicular, 185, 186 

infraorbital, 205 

intercostal, 177 seq. 

interosseous, 187-8, 191 

labial, 205 

lachrymal, 205 

lingual, 206 

lumbar, 177, 192 

malar, 205 

mandibular, 207 

maxillary, 205-6 

median, 158, 159, 186-9, 217, 218, 
219 

musculo-cutaneous, 186, 199, 221 

musculo-spiral, 190, 217, 218 

nasal, 205 

obturator, 192, 194 

occipital, 176, 177 

ophthalmic, 205 



Nerves, palpebral, 205 

peroneal (ext. popliteal), 198 

phrenic, 183 

plantar, 202, 223 

pneumogastric (vagus), 208, 210 

popliteal, 198, 199-200, 220 

post-scapular, 185 

pudic, 203 

radial, 191, 219 

respiratory (of Bell), 185 

sacral, 177, 196-7 

saphenous, 195-6, 197, 222, 223 

sciatic, 197-8, 220 

spinal, 176 

accessory, 208-9 

subscapular, 191 

supraclavicular, 185-6 

temporal, 205 

temporo -facial, 206 

thoracic, 177-9, 192 

tibial, 165, 200 

branches of, 199, 201 

trigeminal, 205, 206 

ulnar, 161, 218, 219 

vagus. See Pneumogastric 
Nervous system, 3-11 

systems, 171 
Norma basalis, 102 

frontalis, 100 

lateralis, 100-101 

occipitalis, 102 

verticalis, 102 
Notches, cotyloid, 41 

intercondyloid, 62, 63 

nasal, 102, 107 

radial, 12, 24 

scapular, 8 

sciatic, 40, 41, 54, 56, 130, 148 

semilunar, 10, 12 

sigmoid, 110 

suprascapular, 7 

(Esophageal opening, 119 
(Esophagus, 116, 131, 138, 143 
Olecranon. See Process 
Omenta, 117, 118 
Omental tuberosity, 125 
Omentum, great, 118 

small, 125, 149 
Orbital cavity, 107 

margins, 104 
Os calcis. See Bones 
Ossification, 6, 8, 10, 13, 15, 41, 45, 47, 

49, 53, 83, 85, 88 
Ovaries, 149, 155 

Palate, soft, 131 
Palmar arches, 15% 160 
Pancreas, 116, 125-6, 142 
Pancreatic surface, 129 



INDEX 



231 



Parasternal line, 211 
Parietal bone. See Bones 

surface of liver, 124 
Patella, 221 
Pelvic floor, 116, 222 
girdle, 3, 36 
organs, 117 
walls, 54, 148 
Pelvis, 39, 41-42, 214, 221 
articulations of, 53 seq. 
false, 42, 91, 117 
of kidney, 129-30 
male and female, 42 
movements of, 91 
small, 122 
true, 42 

Pericardial concavity, 134 
Pericardium, 134, 135, 137, 140 
Perineum, triangular ligament of, 54 
Peritoneum, 117-18, 121, 124, 126, 128, 

134, 148 

Payer's patches, 120, 121 
Phalanges. See Bones 
of foot, 53 
of hand, 15 
Pharyngeal tonsil, 131 
Pharynx, 116, 131-2 
Pia mater, 174, 175 
Pisiform. See Bones 
Plantar arch, 165, 223 
surface, 51 

vessels (internal), 223 
Pleura, 133, 134-5, 138, 211-12 
Pleural cavities, 133 

sac, 133 

Plexus, definition of, 177 
aortic, 180 

brachial, 177, 178, 183-4 
cervical, 177, 181-3 
cceliac, 180 
lumbar, 177, 192-203 
lumbo -sacral, 192 seq. 
pampiniform, 155 
pudendal, 177, 192, 202-3 
sacral, 177, 196-7 
sciatic. See Sacral 
solar, 180 
Plica alares, 64 

synovialis patellaris, 64 
Pons varolii, 174 
Popliteal space, 220, 222 

vessels, 220 
Portal fissure, 125 
system, 155-6 
vein, 125 

Postero -lateral grooves, 175 
Poupart planes, 212, 213 
Poupart's ligament. See Ligaments 

lines, 117, 211 
Presternum, 83 



! Process, acromion, 5, 7, 8, 10, 19 

articular condyle, 110 

basilar, of occipital bone, 102, 106, 
107 

conoid, 15 

coracoid, 7, 8, 19, 36 

coronoid, 10, 12, 22, 23, 110 _ _ 

mastoid, 101, 107, 143 

mesentery, 118 

odontoid, 82 

olecranon, 10, 12, 22, 23, 36, 217 

palatal, 107, 131 

spinous, 89, 111 

styloid, 12, 13, 26, 28, 49, 63, 107, 
110, 218 

temporal, 102 

transverse, of lumbar vertebrae, 129, 
216 

zygomatic, 106, 107, 109 
Pterygoid plates, 102, 107 
Pubes, crest of, 212 
Pubic arch, 76 
Pubis. See Bones 
Pyloric branch of hepatic artery, 150 

end, 119 

orifice, 120 

plane, 213 
Pylorus, 119, 121, 213, 214 

Quadrate lobe, 125 

Radius. See Bones 
Kami, 109-10 

communicantes, 179 
Receptaculum chyli, 169 
Rectum, 116, 122, 130 
Rectus, 99, 212 
Respiratory organs, 131 seq. 

system, 3 
Ribs. See Bones 
Rivini, ducts of, 123 

Sacral region, 215 

Sacro- vertebral angle, 83 

Sacrum. See Bones 

Sagittal plane, 1 

Saphenous opening, 221 

Scalene tubercle, 87 

Scarpa's triangle, 76, 163, 167, 171, 
194, 195, 221 

Semilunar bones. See Bones 

Semimembranosus, tendon of, 62 

Septum, intermuscular, 217 

Serratus magnus. See Muscles 
! Sesamoid bones. See Bones 
! Shoulder, 3, 5 seq., 16, 17, 216-17 
| Sigmoid flexure, 121, 122 

Skeletal system, 2-3 

Skull, articulation with spinal column, 
112 



232 



HANDBOOK OF ANATOMY 



Skull, definition of, 100 

ligaments of, 112 

movements of, 112 

muscles acting on joints of, 112 
Sphenoidal fissure, 107 
Spigelian lobe, 125 
Spinal canal, 89 

column, 89-91 

movements of, 90, 175 

cord, 4, 79, 102, 105, 175 seq. 

furrow, 215 

nerves. See Nerves 
Spine, 8, 215 

anterior superior, 117 

of ilium, post, sup., 220 

lumbar, 216, 219 

pubic, 221 

sacral, 219 

Spleen, 127-8, 214, 216 
Splenic flexure of colon, 122, 214 
Stenson's duct, 122 
Sternum. See Bones 
Stomach, 3, 116, 119, 122, 213, 214, 216 

chamber, 119, 120, 126 
Subcostal line, 117 
Subscapularis. See Muscles 
Supinator longus, 219 
Supraclavicular groups (of glands), 

Supracondyloid triangle, 217 
Suprarenal capsules, 120, 125, 128-9, 

149 

Suprascapular region, 215 
Suprasternal notch, 213 
Surface-markings, on abdomen, 212-13 

aorta, 215 

arm, 217-18 

axilla, 217 

back, 215-16 

diaphragm, 216 

elbow, 218 

foot, 222-3 

hand, 218-19 

head, 210 

heart, 212 

intestines, 214 

kidneys, 214-15, 216 

knees, 221 

leg, 221-2 

liver, 213-14, 216 

lower extremity, 219-20 

lungs, 211-12 

neck, 210 

shoulder, 216-17 

spleen, 216 

stomach, 214 

thigh, 220-21 

thorax, 210 

upper extremity, 216-18 
Sustentaculum tali, 49, 51, 222 



Sympathetic system, 4, 172, 179-80 
Symphysis pubis, 212, 213, 221 

Tarsus. See Bones 
Temporal bone. See Bones 
Tendo Achillis, 51, 222 
Tendons of biceps, 19, 63 
of diaphragm, 138, 216 
extensor, 13, 30 
of ankle, 77 
ext. longus poll., 218 
flexor, 36, 74, 76 
infraspinatus, 19 
peroneus, longus and brevis, 53, 

74, 76, 218 
of popliteus, 62 
of quadriceps extensor, 59 
semimembranosus, 62 
subscapularis, 19 
supraspinatus, 19 
tibialis anticus, 222, 223 
posticus, 49, 76, 222 
of trans versalis, 129 
vasti, 62 

Testicles, 149, 155 
Thigh, 220, 221 
Thoracic aorta. See Aorta 
cavity, 134 
wall, 138, 139 
Thorax, 2, 88-9, 210-11 
Thyroid axis, 148 
Tibia. See Bones 
Trachea, 116, 131, 132-3, 143, 210 
Transpyloric plane, 213, 214, 215 
Transverse plane, 1 
Trapezium. See Bones 
Triangle of Petit, 216 
Triceps. See Muscles 
Tricuspid valve, 139 
i Trochanters, 219, 220 
! Trochlear surface, 12, 21 
Tubercle, adductor, 62 
conoid, 6 
of iliac crest, 219 
radial, 218 
of scaphoid, 33, 222 
of tibia, 222 

Tuberosity, bicipital, 12 
o mental, 125 
of tibia, 221 
Turbinate. See Bones 

Ulna. See Bones 

Umbilical region, 117, 214 

Umbilicus, 212, 214, 215 

Unciform bones. See Bones 

" Uncovered area" of liver, 124-5 

Ureter, 120, 130 

Urethra, 129 



INDEX 



233 



Urine, 12!) 
Uterus, 130 

Vagina, 130 

Valvulse conniventes, 120, 121 

Veins, axillary, 157, 160 

azygos major, 152 

basilic, 160, 161, 162, 217 

cephalic, 160, 161, 162, 217 

coronary, 142 

sinus, 151, 152 

dorso -lateral, 161 

facial, 153 

femoral, 167 

hsemorrhoidal, 156 

hepatic, 125, 154 

hypogastric, 155 

iliac, 155 

ilio -lumbar, 155 

innominate, 152 

intercostal, 152 

jugular, 143, 153, 154, 210 

lumbar, 152, 155 

mammary, 152 

median, 161 
basilic, 36 

occipital, 153 

of lower limb, 167 seq. 

of upper limb, 160 seq. 

ovarian, 155 

phrenic, 154 



Veins, portal, 151, 154, 155 

pulmonary, 138, 151 

radial, 161 

renal, 154-5 

saphenous, 76, 168, 221, 222, 223 

spermatic. See Ovarian 

subclavian, 152, 153, 160 

superficial, 151, 161 

suprarenal, 154 

systemic, 151 

temporo -maxillary, 153 

ulnar, 161 

visceral, 151 
Vena azygos, 152, 154 
Vense cava?, 120, 125, 128, 138, 139, 

140, 149, 151, 152, 154 
Ventricles, 137, 138, 139, 140, 142 
Vertebrse. See Bones 
Vertebral border, 8 

column, 2, 83 

joints of, 89-90 
Villi, 120 
Visceral surface, 125, 127 

Wharton's duct, 122 
Willis, circle of, 145, 175 
Wings of sphenoid bone, 1 1 1 

Zygoma, 111, 122, 145 

Zygomatic process. See Process 



rt, Tindati tf: Cox, 8, Hmntlta S /, C.<.,it cft/x/e/ 



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Date Due 



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UNIVERSITY OF CAUFORNIA LIBRARY